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Our view: Responsible steps needed to restore health care predictability

There are so many changes and uncertainties, it’s hard to keep straight what to do, what will be covered and what it will cost

Published on October 28, 2017 12:01AM

Last changed on October 30, 2017 10:27AM

Open enrollment for Affordable Care Act coverage starts Nov. 1 and runs through Dec. 15 for health care policies starting Jan. 1, but it would be understandable if many Americans are unaware of these important dates. They should at least review their current coverage, in order to avoid being locked into something they don’t like for another year.

The Trump administration has cut back on efforts to inform people about deadlines and other matters pertaining to the ACA — part of a strategy of sabotaging the national health care system sometimes called Obamacare. The White House also has axed billions in funds to subsidize insurance policies for Americans covered by the act, suggesting the payments amount to a taxpayer-funded subsidy for insurance companies. (This is a valid point; the ACA was modeled on a Republican-designed system in Massachusetts that was highly accommodating to private insurers.)

None of this should come as a surprise, considering Donald Trump and congressional Republicans ran for office on a platform of undoing Obamacare. Unfortunately for ordinary citizens, the haphazard way they are going about it is making matters worse instead of better. There are so many changes and uncertainties, it’s hard to keep straight what to do, what will be covered and what it will cost. Since insurance depends on sophisticated analysis of facts and risks, the marketplace is reacting to all these open questions by raising prices on the policies some Americans are legally obliged to buy.

The good news in the Pacific Northwest is that coverage options and financial assistance remain available to Oregon and Washington state residents. The president’s elimination of subsidies — apart from causing insurance companies to raise premiums in anticipation — isn’t expected to have a dramatic impact on those who make up to 2 1/2 times the federal poverty level. For a family of four, that comes to $60,750 in 2017. What they lose in more expensive premiums, they will make up in income tax credits on those premiums.

This will end up costing the U.S. Treasury even more. “The nonpartisan Congressional Budget Office forecast that ending cost-sharing reductions would increase the federal deficit by $194 billion over a decade, because the tax credit amounts would increase and because more people would receive them,” the Washington Post reported.

People in the next income tier — up to four times the federal poverty level — also make out OK in the short run, thanks to bigger tax credits for popular silver healthcare plans.

It is Americans in the highest tier — those ineligible for tax credits — who will be hurt the most directly by rising premiums. These premiums are becoming more and more crushing, at the same time coverage becomes more limited. It’s hard to imagine this trend being sustainable for the relatively small percentage of people who buy their own policies, rather than being covered through their employer or by Medicare or Medicaid.

Last week, U.S. Sens. Lamar Alexander, R-Tennessee, and Patty Murray, D-Washington, proposed a two-year extension of subsidies in order to stabilize the insurance marketplace. This is a smart idea, but the president appears to be against it.

Besides all the angst this causes for Americans wondering what our health care laws will be from one year to the next, the real significance of all these political gyrations is how it discombobulates a huge segment of the U.S. economy, one on which we rely for essential services. Hospitals like St. Anthony in Pendleton and Good Shepherd in Hermiston — and all their individual medical providers — depend on predictable payments by private and public insurers. Medicare reimbursements have declined and slowed for years. And now the private leg of the health care platform is getting more and more shaky. We all face a steep price for incompetent national political management of this literally life-and-death business.

Speaking about Trump’s subsidy decision, one industry expert commented, “I think it will create a lot of uncertainty — and it’s a cumulative uncertainty created not only by this decision of this administration, but the executive order, the question of will Congress step in, what will the agencies do.”

The ACA is far from perfect, but most people were getting used to it. But jerking it all around is making it more expensive and less reliable. This is not what any sensible person wants to happen. It’s time for responsible steps to restore health care predictability for all.

(For those with easy internet access, visit healthcare.oregon.gov.)


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