The Affordable Care Act, Obamacare, received a boost last week when health insurers submitted the prices at which they will offer coverage in California.
The rates are surprisingly low, despite projections of sticker shock bandied about by the law’s opponents.
The California bids are important. The State has the nation’s largest population; one-fifth of its non-elderly citizenry is uninsured; and the individual health insurance market is poorly regulated. Many feared the worst.
Projections had assumed that a medium-cost plan on California’s health exchange — what’s commonly called a “silver plan” — would carry an annual premium of about $5,200. Instead, the average silver plan premium will be roughly $3,300 — nearly $2,000 less than predicted. Even that figure is illusory as many Californians will receive federal subsidies, substantially lowering their monthly premiums.
To be sure, there will be problems in fully implementing Obamacare at the beginning of next year. It’s a complicated program; simpler options, like Medicare for all, were rejected out of hand as politically not feasible. As a consequence, administrative confusion as the law goes into effect is likely, especially in states where Republicans are sabotaging the law.
No law in the last century as sweeping and complex as Obamacare has been passed and implemented without substantial changes in subsequent months and years. Medicare, for example, was enacted in 1965, changed in 1967 and 1972. The 1935 Social Security Act was strengthened four years later by the adoption of the family protection program, which allowed dependents and survivors of covered workers to claim benefits.
The Affordable Care Act was enacted three years ago; there is a large list of pending fixes and clarifications. But given the partisan gridlock in Washington, corrections to the law are not likely. Republicans are as hostile to the law now as they were in 2010; moreover, they see an election year advantage if there are problems in implementing Obamacare in 2014. The GOP has no incentive to work with the president and Democrats in Congress to fix the glitches. Congressional Republicans would rather spend time and effort posturing for the folks back home by voting — 37 times to date — to repeal the law. Democrats, fearing defeat at the polls next year, are frightened to reopen the health care debate.
Republicans are doing their best to undermine Obamacare in the states they control. Roughly half the states have refused to expand Medicaid, despite the generous federal subsidies contained in the new law. Their refusal means that millions of poor people will remain uninsured.
It’s a cruel irony. The poorest of the poor, those living below the shockingly low poverty line, will not get health insurance in states that turn down Medicaid expansion. Meanwhile, people in those states with incomes up to four times the poverty level (up to $45,960 a year for an individual) will be entitled to federal subsidies to assist them in buying health insurance. Obamacare intended for those below the poverty line to enroll in expanded Medicaid, now not an option in many Republican-controlled states.
More than half the people currently without health insurance live in states that have declined Medicaid expansion.
Despite the problems and continued Republican harassment, Obamacare will go into effect next year. Millions of uninsured Americans will gain affordable health care; millions more will have the security of knowing such care is available should they lose a job that comes with health insurance.
There will also be a stark contrast between blue states and red states; between states like California, which is doing its utmost to implement the law and where nearly everyone will have access to health insurance, and states like Texas, where Governor Rick Perry has turned down Medicaid expansion, leaving the state’s large poor population mostly without coverage.