Throughout the many decades in which politicians, of both parties, tried to get something called "health-care reform" done, the primary goals of such efforts could essentially be summed up threefold:
1. Get uninsured people insured.
2. Bring costs down by, inter alia, reducing uninsured medical risk and managing insured risks more efficiently.
3. Protect consumers from the more egregious, abusive and harmful practices of medical insurers.
Whether and how the Affordable Care Act accomplishes, attempts to accomplish, or has a chance to accomplish, these goals is separate from the core principle that these were, and are, its goals from the outset. This is why health-care reform, in whatever form it took shape, has been and is needed: Too many people are uninsured, too many people can't afford even basic medical care or treatment, and insurance companies are gouging and abusing consumers in unacceptable ways. Irrespective of its success or its chances of success, that's what the ACA was enacted to address.
Any time a major change in the law occurs, whether via Congress or the Supreme Court, there are always going to be people who are better off than they were before, and people who would have been better off without it. The standard for judging the ACA appears to be that if anyone, anywhere, falls into the latter category, then the law is a failure and must be repealed, no matter how many fall into the former category or the nature of what "better off" actually means. But that's not what I'm here to discuss today.
There are plenty of people out there who have reported that "because of Obamacare," the fabulous, awesome, cheap, total-coverage insurance they had before is gone, and the only thing they can get now is a policy that covers practically nothing and costs a fortune. In other words, this law that explicitly requires insurers to cover more and charge less, has caused insurers to cover less and charge more. Or, I should say, has forced insurers to, reluctantly, cover less and charge more.
"Gee, Bob, I'd really love to offer you and your employees a group policy that covers every medical procedure under the sun with no deductible for $1 a year. But, because of Obamacare, all I can offer you is a policy that covers only aspirin and Band-Aids, with a $500,000 deductible, for $8,000 a month. Take it or leave it."
Maybe this is a realistic scenario, maybe it isn't.
The irony is not that a law specifically and deliberately designed to expand coverage and reduce cost has had the precise opposite effect, even if and to the extent that it has actually done so. The irony is that, far from putting the brakes on abusive and dishonest practices of medical insurers, it's had the effect instead of giving them a license to keep abusing their customers by blaming that abuse on the law itself, and on the President who asked Congress to assemble, draft and pass it.
I would venture a guess, and I could be wrong, that no single federal statute has ever been the subject of so much misinformation, mischaracterization and misdirection, not to mention vague, unfocused, irrational outright loathing. One time I responded to the question, "What is Obamacare?" (or "What is the Affordable Care Act?") with the simple answer, "It's a federal statute that regulates the medical insurance market." No matter what your opinion of it or your feelings about it, that's what it is. But I haven't run into very many people who even know that the Affordable Care Act is a federal statute, let alone a federal statute that regulates the medical insurance market. The other ideas about what it is, don't need repeating or description here.
But I'm getting away from the point again. "Obamacare" is just this thing, this thing that exists, that's out there, like the "beastie" in Golding's Lord of the Flies. No one knows what it is, no one can identify it, no one can describe it, no one has seen it, they just know it's out there and they just know it's a threat. And it's something insurers can use to take advantage of their propaganda-soaked customers who will believe anything they're told as long as it validates their belief in, fear and loathing of, the "beastie." If I'm an insurer, and I know I can raise your premiums or your deductible, reduce your coverage or deny your claim, and you'll blame the law and the President of the United States and everyone who voted for him, everyone and everything except me, and I know you won't do your research and shop around, or even consider whether what I'm telling you is true, why wouldn't I milk that for all it's worth? That's capitalism, right?
The reality is, there isn't a thing insurers are doing now that they weren't doing prior to 2010; raising rates, changing provider networks, canceling policies, denying claims, &c. The ACA was supposed to put a stop to some of it, cut down on some of it, reduce the impact of some of it and give consumers a better deal on some of it. Instead, it's given insurers carte blanche to not only keep doing it but double-down on it, because they know that the President, his party, his cohort and the law will be given the blame instead.
I don't think this makes the law a bad one or a failure, per se; I've never bought into the idea that any statute can or should be judged in such a binary way in the first place. (Is ERISA a success or a failure? Is TILA good or bad? Are you for or against the Lanham Act? Why are these questions not polled vis-a-vis these or any other statutes besides the ACA?) Again, I think the question of how and to what extent the ACA is accomplishing, or can accomplish, its primary goals is an open, mixed and complicated one. Binary judgment and conclusive blame are easier than open-ended inquiry and analysis.
There is, and has always been, merit to the idea that the fundamental flaw in the ACA is that it leaves medical insurance in the hands of the private insurance industry, and doesn't create a universal public insurer that many liberals want and have wanted for decades. Whether that was feasible or not is a separate debate I don't want to have here. Would the creation of a public insurer (or expansion of an existing one) as an alternative to private insurance have made it less plausible for insurers to blame the law and the President for their own abusive practices? Or would it have driven some consumers even deeper into the arms of private insurers, for similar reasons, with similar results?
I don't know if there's a legislative or administrative fix for those insurers who are milking their customers' hatred of the law and/or the President and getting away with it. The only solution, really, is for people to do their homework, shop around, not simply accept what their insurers are telling them, and understand that medical insurance like everything else is a stew with many chefs.
Somehow I don't see that happening any time soon.