Recently, President Biden invited former President Obama to the White House for a celebration of ObamaCare and to push for expansion of its rolls. It has now been 12 years since the passage of this new healthcare legislation in 2010 and now seems a good time to review just how well the Affordable Care Act – ACA (ObamaCare)has lived up to its hype.

John C. Goodman, healthcare economist helps us remember the promises made by Barack Obama when he ran for president the first time in 2008. He pledged the following:

• Insure the uninsured with private coverage
• Bring down healthcare costs, with savings of $2500 a year for every family
• Give people with inadequate insurance better insurance
• Protect people with good coverage – “If you like your doctor, you can keep your doctor.”
• End discrimination against people with pre-existing conditions

 

Now let’s look at the actual record.

Expanding Medicaid

Despite all the hype about increasing the rolls of the insured, nearly all of the gains made in that area are due to increased Medicaid enrollment. In fact, some have referred to the ACA as the “Medicaid Expansion Act.” Millions were intentionally newly enrolled in Medicaid by expanding the eligibility requirements, but millions more were illegally enrolled because of lax governance – leading to billions of dollars of improper payments.

This is not what voters were promised. Medicaid pays the lowest rates to providers, so many doctors won’t see Medicaid patients. Those that do will usually have limited numbers of appointments in their schedule for these patients. That leads to poor access to healthcare for Medicaid enrollees and that leads to overcrowding in emergency rooms for primary care. The result is poor quality healthcare.

How poor you say? The Oregon Health Insurance Experiment is an ongoing study begun in 2007, which has already revealed significant information. Thus far, researchers have learned that having Medicaid does not improve health, at least in standard measurements of blood pressure, blood sugar, and cholesterol. Medicaid reduced observed rates of depression by 30% but increased the probability of being diagnosed with depression. Medicaid significantly increased the probability of being diagnosed with diabetes and the use of diabetes medication, but did not have the expected impact of lowering blood sugar.

Goodman has said that having Medicaid may actually be worse than having no insurance at all. This statement is supported by the fact that Medicaid enrollees are 40% more likely to use the Emergency Room than the uninsured. Therefore, expanding Medicaid, rather than relieve the overcrowding of emergency rooms, has probably made it worse. Moreover, the influx of mainly healthy people onto the Medicaid rolls has apparently siphoned money away from developmentally disabled children on the state Medicaid waiting lists. Thousands of these children die every year, according to Goodman, who might have survived with proper care.

Wasting Taxpayer Dollars

Meanwhile, most of the money spent on private coverage has accomplished very little. Despite spending more than $50 billion a year on ObamaCare subsidies in the individual health insurance market, the increase in coverage prior to the pandemic was anemic. Goodman calculates we spent about $25,000 of subsidy every year for every newly insured individual, or $100,000 for a family of four. Moreover, if we consider the offsetting reduction in employer-provided coverage over the same period (partly as a result of ObamaCare), you could argue that the entire $50 billion was money down the drain.

Making Insurance Unaffordable

The name of this healthcare reform bill, the Affordable Care Act, would seem to be a misnomer. Between 2013 and 2019, premiums in the individual market more than doubled and deductibles skyrocketed. Combining the average premium with the average deductible, last year a family of four not receiving a subsidy had to pay $25,000 out of pocket before receiving any benefits at all from their health plan!

Then consider low-wage workers employed by fast food chains and others. Under the law, employers are required to offer coverage and charge their employees no more than 9.6 percent of the employee’s annual salary. However, these plans can have a deductible of $8,700 and the employee must pay the full premium to cover any dependents. This has been referred to as the “family glitch.” (see Biden’s Fix of the ObamaCare Glitch) Most workers turn these offers down and then they are not entitled to any subsidies.

Throwing Good Money after Bad

The declining attractiveness of ObamaCare insurance, if unsubsidized, has left many healthy people without coverage. To patch this leak in the dyke, Congress created new subsidies for families above 400 percent of the Federal Poverty Level (FPL) with the American Rescue Plan – passed without a single Republican vote just like ObamaCare. Goodman says not only are these subsidies regressive, they are also very wasteful – since they go manly to people who are already insured elsewhere. On net, the new subsidy is costing an estimated $17,000 a year for every newly insured person, or $68,000 for a family of four.

Outlawing Insurance that Meets Family Needs

We all know by now that Obama’s promise that “if you like your doctor you can keep your doctor” was false. Obama tries to defend this broken promise by insisting his program substituted better insurance for “junk insurance.” This statement is also false.

A popular alternative to ObamaCare is short-term, limited duration insurance (STLD). These plans get around the onerous and expensive “essential health benefits” of ObamaCare that make it unnecessarily expensive. Yet Obama restricted such plans. President Trump rescinded this decision, making more of these plans available. Naturally, Biden intends to reverse Trump’s decision.

Making Things Worse for Patients with Pre-existing Conditions

Perhaps the most popular provision of ObamaCare is eliminating pre-existing conditions as a cause of disqualification. Yet, the reality is that problem affected few people due to federal risk pools that allowed those with pre-existing conditions to still get affordable coverage. Only about 100,000 people ever used these pools in a given year.

Today, due to the escalating cost of insurance coverage, everyone who comes to the individual market faces sky-high premiums and deductibles and narrow networks that exclude the best doctors and hospitals. ObamaCare insurance is not accepted at the most prestigious medical centers and most popular doctors’ offices throughout the country.

Broken promises and escalating costs are the legacy of ObamaCare today.

After more than two years, the Covid pandemic is finally winding down. Hospitalizations and deaths are declining rapidly, although the number of new cases is difficult to quantify due to the availability of home test kits. But clearly the emergency situation is abating – except in the eyes of the government.

Health and Human Services Secretary Xavier Becerra recently extended the national public-health emergency for another 90 days. Why would he do that? The Wall Street Journal editorial board says because a permanent crisis means more dependence on government.

The Trump administration first invoked the emergency under the Public Health Service Act on January 31,2020 to reduce red tape for healthcare providers. Congress then linked an expansion of Medicaid and food stamps to the declaration. Progressives liked that and now they don’t want the emergency to end.

How did the emergency declaration change the situation?

The Families First Coronavirus Response Act of March, 2020, suspended food-stamp work requirements for able-bodied adults without dependents during the emergency. These individuals normally can’t receive benefits for more than three months over a three-year period unless they work or participate in a work-training program. Congress also boosted benefits, so the average monthly payment is now double ($240 per person) what it was in 2019.

Suspending work requirements was intended to help workers laid off during lockdowns when few jobs were available. But once lockdowns eased, businesses were desperate to hire. The sweetened food stamps and suspended work-requirements – on top of enhanced unemployment benefits and other transfer payments – reduced the incentive to work. Now you know why the service has slowed down at your local fast-food restaurants!

The Biden Administration is bragging about the low unemployment rate of 3.6% in the latest jobs report. But the reason for this is the low labor participation rate of 62% – people just don’t want to work. There are currently 1.8 job openings for every unemployed worker. Why work when the government is making it easy not to work? As of January, there were nearly 2.5 million more households receiving food stamps than in 2019 and 500,000 more than in April 2020.

Democrats like this situation because they count on the unemployed to vote Democratic. They’re happy to extend these benefits at least until after the November mid-term elections. States may end the supplemental food stamps before the public-health emergency is lifted, but only a dozen or so have done so. Even Republican governors struggle to resist free federal money, and they worry about being attacked for refusing extra benefits amid rising food costs, even if beneficiaries aren’t poor.

What has been the impact of the pandemic on Medicaid enrollment?

Congress increased Medicaid funding for states during the emergency on the condition they don’t remove beneficiaries from their rolls, even if they earn too much to qualify. As a result, Medicaid enrollment has swelled by more than 14.6 million (20%) since February 2020 – more than the increase in ObamaCare enrollment since President Biden took office.

A recent JAMA study found that Wisconsin Medicaid enrollment increased 11.1 percent more than would be expected based on economic factors during the first seven months of the emergency, mostly because ineligible beneficiaries weren’t kicked off. Some states now want to prune their rolls but can’t without losing federal funds. Congress has hooked states on federal transfer payments, and Democrats want them to stay hooked. (Never let a crisis go to waste!)

Have there been any benefits from these emergency rules?

Yes. These emergency rules have let Medicare cover telehealth services and waived a Medicare requirement that beneficiaries be hospitalized for three days before the cost of nursing-home care is covered. These are benefits that should be made permanent. It has long been anathema that the federal government insisted people stay in hospital a full three days before paying nursing home benefits. Why waste money on unnecessary hospital charges when you can save money by getting people into a nursing home sooner?

 

Our political world is changing. There has been evidence of this for quite some time. But a recent cartoon has dramatically illustrated this change.

My wife grew up in Florida and in her home town she never knew a Republican. She and her family were southern Democrats – which meant conservative common folks who believed in hard work and expected the government to protect them from criminals and foreign powers. They hoped the government would look out for “the little people.”

In 1995 these same Democrats formed the Blue Dog Coalition. The term “Blue Dog Democrat” is credited to Texas Democratic representative Peter Geren, who later joined the Bush Administration. The term is said to have been cited by members because “when dogs are not let into the house, they stay outside in the cold and turn blue.”

In 2008 this coalition had 59 members. At that time, they were a powerful force in Congress as evidenced by their influence which removed the “public option” from the new healthcare bill now known as ObamaCare. But the coalition suffered serious losses in the 2010 midterm elections, losing over half of its seats to Republican challengers. Today, the coalition has only 19 members and their influence has likewise declined.

This shift in the Democratic Party has been happening for a long time. President Ronald Reagan, a lifelong Democrat who switched to the Republican Party famously said, “I didn’t leave the Democratic Party, the Democratic Party left me.” But apparently it has gotten much worse. In a recent article in The Wall Street Journal, Colin Wright, a life-long Democrat expressed his opinion that his party has left him by moving so far to his left that he now believes his views are right of center, even though he hasn’t changed. He dramatically illustrated this in a cartoon which has gone viral on Twitter.

The cartoon shows the political spectrum in three years; 2008, 2012, and 2021. Mr. Wright draws himself left of the center in 2008 where he says he has been all his life. Here is his explanation for the cartoon: “I created the cartoon to help sort out my feelings of increasing political alienation from the left. I’m a lifelong Democrat. I turned 18 in 2003 and have never voted for a Republican. But over the past decade, and especially the past five years, I’ve watched my party distance itself from the values and principles I hold dear.”

“People on the left once viewed free speech as sacrosanct and championed speaking truth to power. Now they disparage open expression as a danger to democracy and minorities. The aspiration of judging individuals by the content of their character rather than by the color of their skin has given way to identity politics and “equity’ initiatives that prioritized group interests over individual rights.”

“Women’s rights, previously understood as relating to their oppression on the basis of sex, is now viewed by the left through the lens of gender identity, which gives priority to men who declare themselves to be women. Today’s progressive can’t even tell you what a woman is. The right may be inconsistent in its support of free speech, individual’s rights, and women’s rights, but the left is consistent in its opposition to all three.”

A careful analysis of Wright’s cartoon shows that although his political beliefs have not changed, the movement of the Democratic Party, and progressives of the party especially, has gone so far to the left that Wright now finds his political position is actually right of center. This is consistent with the declining influence in Congress of the Blue Dog Coalition.

Wright mentions that “Today’s progressive can’t even tell you what a woman is.” This was the reaction of newly approved Supreme Court Justice Ketanji Brown Jackson. When asked by Senator Marsha Blackburn to define a woman, Jackson answered, “I’m not a biologist.” This is a revealing answer for this progressive new justice. Ironically, Wright is an evolutionary biologist and yet he had received criticism for his biological views. He says, “I am an evolutionary biologist, and from 2008 to 2020 I worked to become a university professor. But while working as a postdoctoral fellow at Penn State in 2018, I found myself ostracized by scientific colleagues and people I thought were close friends because I was unwilling to promote scientifically inaccurate claims about biology to avoid offending those who identify as transgender.”

This is the state of our current political system. Even those who have always considered themselves liberal feel “left out in the cold” by the far-left liberals and progressives who dominate our political conversation. This is an unsustainable situation that truly is a threat to our democracy. When even liberals aren’t allowed to express their views to other liberals without fear of retribution, the left has gone too far. We should all hope for a political correction in the next election.