As Obamacare Turns 14, It Continues To Bully U.S. Patients

 arch 23 marks the 14th anniversary of the passage of Obamacare, also known as the Affordable Care Act (ACA). At the signing ceremony, then-Vice President Joe Biden famously remarked, "This is a big fucking deal!"

How right he was—much to the chagrin of patients, who have been stuck with the monstrosity that is the Affordable Care Act ever since.

For the last decade, Obamacare has driven the cost of health coverage up and the quality of care down. It's long past time to advance market-oriented reforms that would actually yield more affordable care.

Americans are paying more for health coverage than ever before. In 2019, just five years after Obamacare's cost-inflating regulations took effect, average premiums had more than doubled, compared to what they were pre-ACA. Premiums have since continued to climb. The average family in 2023 paid 22 percent more for employer-sponsored coverage than they did in 2018.

Deductibles have also spiraled out of control. For mid-level silver plans, deductibles have doubled since 2014. Having to spend ever more out of pocket before receiving a dime from their insurers may cause people to question why they're buying Obamacare insurance in the first place.

These cost increases are no accident. They were baked in from the start. Obamacare's mandates are designed to increase costs for the general population as a means of subsidizing coverage for favored groups.

The law prevents insurers from setting premiums for older patients at more than three times those for younger people—despite the fact that older patients' claims costs are significantly higher than that multiple, on average. So young people's premiums are higher than they would be absent Obamacare.

Another mandate requires insurers to sell to all patients, no matter their health status or medical history. The effect, again, is to raise costs for everyone rather than subsidizing coverage directly for high-risk patients. The law also mandates that exchange plans cover 10 "essential" health benefits—including mental health services and behavioral health treatments—even if patients don't need or want them.

In 2023, exchange enrollment broke records, with more than 16 million Americans signing up. Record enrollment is a function of the lavish premium subsidies that Democrats have used to blunt the impact of those skyrocketing premiums. Most enrollees have no idea how much their insurance costs because taxpayers are covering much of the tab for them.

Once they sign up, they may find that their exchange plans confine them to narrow provider networks. As a result, patients often have to travel long distances or wait for care—particularly in rural, less populated counties. According to a 2022 report by the Government Accountability Office, the Centers for Medicare and Medicaid Services identified almost two-thirds of insurers they examined as "not in compliance with network adequacy standards" for the year ahead.

So yes, Obamacare has proved itself a "big fucking deal"—for all the wrong reasons.

Thankfully, there are alternatives to this legacy of failure. Congressional Republicans have proposed a number of ideas for leveraging the power of market competition to make insurance and care more affordable.

One measure, the ACCESS Act, would allow lower-income families eligible for cost-sharing reduction subsidies under Obamacare to receive those funds in a tax-advantaged health savings account. At present, that money goes directly to their insurer to reduce their out-of-pocket obligations. Under the ACCESS Act, they'd control that money. If they want a therapy that their insurer doesn't cover or would like to visit a doctor not in their health plan's network, they can use their HSA funds to pay for it.

Another bill—the Healthcare Fairness for All Act—would, among other things, allow people under age 65 to receive a tax credit of up to $4,000, and children a credit of up to $2,000, to put toward insurance premiums or out-of-pocket costs. Once again, patients—not insurers—decide how their health care dollars should be spent. Whatever they don't spend each year could be contributed to a health savings account (HSA) and carried forward into future years. Injecting more consumerism into the health care market in ways like these will force providers to improve quality and reduce their prices.

At age 14, Obamacare has developed a habit of bullying U.S. patients. It's past time they got more choices, not fewer.

Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020).

https://www.newsweek.com/obamacare-turns-14-it-continues-bully-us-patients-opinion-1878093