Obamacare doesn’t solve North Carolina’s health care problems
Every era has its one big issue to face. Ours is health care. The Affordable Care Act, or Obamacare, had two primary goals: to reduce healthcare costs, especially taxpayer support, at the same time improving health outcomes. Polls show growing numbers of North Carolinians don’t believe it will succeed.
Obamacare’s success depends on the mandate that all have health insurance. Best estimates are that 1.5 million (roughly 15 percent) North Carolinians are uninsured, about the same as national percentages. One great myth is that the uninsured do not get health care. They do and most get it from hospital emergency departments that by law cannot deny them, even though it is the most expensive care available. Since many cannot pay for this care, costs are shifted to those with insurance and to the public. Obamacare postulated that by expanding those eligible to receive Medicaid and by subsidizing those unable to afford health insurance usage of the emergency department would be dramatically reduced, substituting relationships with primary care physicians providing less expensive routine and preventive care. Even with an initial increase in government support ACA advocates believed the net result would be substantial health care cost savings.
Let’s look at the numbers. Individuals earning less than $43,000 or families of four earning less than $89,000 per year are qualified to receive federal health insurance subsidies. In September 2013, the Census Bureau reported the 2012 U. S. median household income was $51,017. For full-time, year-round workers the median is $49,398 for men and $37,791 for women. 2011 Census data reports North Carolina’s median per-capita income was $25,256 and median household income was $46,291. Unquestionably a large cohort in North Carolina will qualify for varying subsidies.
Theories and outcomes are often different. ACA details took too long to materialize and many of the requirements make no sense and are counterintuitive. If Obamacare’s goal was for everyone to have health insurance the decision that existing policies would be noncompliant if they didn’t include maternity and other coverage was counterproductive.
Postponing the requirement for businesses to insure their employees, the President’s promise not to enforce the carrot-and-stick fines for those who did not enroll and the abortive October start-up further stirred the pot, but the icing on the cake was last week’s pledge to allow non-compliant policyholders to keep their current plans another year.
Adding insult to injury was the announced rate hikes of between 16 and 24 percent to those current policyholders.
North Carolinians are confused, angry and have lost confidence in Obamacare. No wonder only 1,700 signed up in October, the first month enrollment was open. 15,000 more learned they were eligible for insurance subsidies and 7,000 qualified for Medicaid.
The ACA will almost certainly fail to yield enough enrollments to produce projected cost savings; more likely is that public taxpayer costs will soar and health insurance rates for those covered will increase. And once public benefits have begun they are almost impossible to rescind. Congressional Democrats are likely to bear the brunt of public disillusionment in the November 2014 elections and, if enough Republicans win Senate seats, there is a strong chance Obamacare will be repealed. Under any scenario it will be modified.
And we still won’t have resolved the big issue of our time.
Tom Campbell is former assistant North Carolina State Treasurer and is creator/host of NC SPIN, a weekly statewide television discussion of NC issues airing Sundays at 5 a.m. on WLOS-TV. Contact him at www.ncspin.com.