THERE’S BEEN no mistaking through my writing that I’m not a fan of the Affordability Care Act, though individual passages are very positive for people. The Act on whole is not, especially when compared to single payer, which will become more and more apparent next year.
Ben Smith of Buzzfeed picks up on one of the issues that is going to start to shake out that proves just how badly ACA ares when compared to single payer.
State and federal officials and the health care industry are currently preparing to implement two specific ObamaCare provisions taking effect on January 1, 2014, acting on this politically perverse principle of shifting resources from your supporters to your opponents. The first is the individual mandate, which aims to force the young, childless, and healthy – “Young Invincibles,” as they are said to think of themselves – to buy heath insurance, even if they think (and even perhaps make a rational, if risky, bet) that they don’t need it.
The second is a lesser-known policy to limit the practices of charging different premiums to different ages, known as age-rating. Many states currently set a limit on this difference, often mandating that an old person shouldn’t pay a premium more than five times a younger person’s, even if she’s expected to use more than five times as much health care. The ObamaCare provision kicking in next January 1 would reduce that ratio to three-to-one, essentially limiting what the elderly pay in part by forcing young people to carry a larger share of the total cost of national health care.
Ben Smith couches this in a provocative headline that states “Obama prepares to screw his base.” Smith posits that to protect the elderly, who didn’t vote for Obama, ACA will shift health care coverage to younger people, those individuals who have supported Barack Obama from the start and set his presidential ambitions on firm ground.
But young people get old too, right? It’s a goes around comes around health care philosophy.
According to AHIP, the average premium paid by a 24 year old in the individual marketplace is $1200 a year. Using AHIP’s numbers, the price of making the cost of heath insurance more equitable for a 60 year old will potentially cost that 24 year old, on average, an extra $45 a month.
While I don’t mean to minimize this increase, as I recognize that every dollar counts when one is young and getting started, it is important to keep the actual price tag in perspective and weigh the equities when considering that those at the older age range have been overcharged for many years.
The reality is that the young have been paying unreasonably low premium rates for for a very long time–it being in the health insurance company’s profit interest to bring in as many young and healthy people as possible in the door by charging artificially low rates. The problem is that they make up for it by charging artificially high rates to the older people the insurance company would rather not have in the first place. What the ACA seeks to do is correct this situation so that 60 year olds are not precluded from gaining health insurance coverage by being priced out of the market.
Note that this problem could have been averted for younger Americans had we lowered the Medicare age to 55 however this was not acceptable to the Congressional GOP.
Smith cites Health Care Blog’s Maggie Mahar, who first brought the subject up last August.
Under reform, more states could decide to ban age rating, or follow Massachusetts’ example, and limit the ratio to 2:1. But, politically, this would be a third-rail decision. If older boomers pay less, younger adults would be charged more, and most are vehemently opposed to being asked to support the Pepsi Generation. As one of my younger readers once commented, “I’m willing to help my mother, but not someone else’s mother.” [Health Care Blog]
Theoretically, it sounds like a prescription for making a lot of conservatives to me (and always has), but this is the reality of ACA versus single payer.
But as we also know, President Obama made back room deals very early with private insurance and big pharma, even as he pretended that the public option was still a possibility.
Now we’re stuck with ACA.