Heath Insurance Exchanges: Were They the Solution?
OPINION --Diane Lund asked me to reflect upon what the Accountable Care Act (ACA) has done and where we are in its progress, particularly with respect to Health Insurance Exchanges (HIEs). A few months ago, I suggested that it might make sense to delay the individual mandate, given that the employer mandate had been delayed a year. Unfortunately, as of yet, such has occurred. One wonders whether some believe it is better having the individual mandate without the employer mandate or is it just politics as usual. That is, if it is such a good idea to have the individual mandate start a year before the employer mandate why was the original legislation not drafted that way. Or was it read by so few in Congress that it did not matter.
Well, we now have the Exchanges, or at least we seem to. The first few days of logging on appeared to be reminiscent of the first few days of logging on to a major airline’s website to print a boarding pass after the information technology “conversion” as part of a major merger. I was in Boston at the time, and I entered what I now believe was an infinite loop. For those of you with programming backgrounds, you know this took me nowhere, but certainly not to a boarding pass. The problems on the first day of the HIEs noted, included “frozen” sites, lags in time, errors, etc. When I could not print my boarding pass from my Boston hotel, I went to the airport a few hours early to try to sort out the situation. Unfortunately, this alternative did not appear to be available to many that sought to access their respective HIE.
It never ceases to amaze me that with all the technological advances, implementations and conversions are often so poorly handled and new websites being brought on line like the Exchanges do not seem to work that well at first. A frequent problem cited as to why the first few days for many of the HIEs were difficult was because too many people tried to access them. I thought that was the whole idea to make them available for people to choose a health plan.
The hope seemed to be that more people would choose to purchase health insurance, and for those of us less fortunate, there would be subsidies to assist in purchasing that insurance. The hope was that employers would still provide health insurance coverage to their employees. If such was the hope and dream, why are we hearing so many stories of healthy people suggesting they will pay the “tax,” certain people not being eligible for the a subsidy, or they do not think it will be enough, but still not qualifying for Medicaid, and employers sending their part-time employees to the Exchanges and/or limiting their hours?
When I penned this Commentary at 34,000 feet in the air on a flight to our Nation's Capital, which I was not sure was open or not, I had been looking at an offering for medical and dental insurance for a employer group. That offering for 2014 for an employee and her family cost over $1,400 per month. Although I assume that much of this amount may be subsidized by one's employer, if this is the cost of coverage, how many Oregonians can afford over $16,000 a year for healthcare coverage. Since probably not that many, it is no wonder that so many people flocked to the exchanges on the first few days.
There are press reports of the rising prices of the stock of investor-owned hospital companies, in part due to more individuals having health insurance. Yet there also are stories of many nonprofit hospitals laying off workers. There are numerous press reports of how the ACA will exacerbate the clinician shortage and how healthcare might have to be delivered in a different model.
Some say this is the Administration’s grand experiment and it will all get sorted out somehow. Perhaps, it will, but like the Government shut down, the debt ceiling, etc., it is a quite painful experiment for many. Now, with the Government back open, more scrutiny may be directed to the Exchanges.
Maybe many more members of Congress should have read what they voted for. Perhaps, they should have looked more carefully at the skyrocketing costs of healthcare in Massachusetts after the enactment of “health reform” there? Perhaps, they should have considered a phase-in? Perhaps, they should have listened less to special interests and focused more on citizens, their healthcare and their access to care?
We may never know, but we do know is that not everyone intended to be covered will be covered and not everyone covered will have access to healthcare. One hopes that this hasty “experiment” will not set us back many years in the laudable goal of having all American have access to healthcare.