Every year, as insurers tally up the good or bad news about policy costs on the insurance exchanges, we cannot help but reflect on the chaotic origins of the Affordable Care Act, aka Obamacare, passed by Congress in 2010.
It was a sprawling bill that was mired in partisan conflict from the beginning. We did not endorse it then, in part because of serious doubts about the unintended consequences of such a sweeping change.
If the Affordable Care Act was maybe too much at one time, some of its provisions were broadly popular and remain so today, like insurance being available for people with pre-existing medical conditions. Before Obamacare, too many were denied health insurance on flimsy medical grounds.
But this "guaranteed issue" is expensive, and insurers argue that the steep increases in premiums for policies on the new insurance exchanges were needed because of these new costs.
Has all this sorted out? Not exactly.
In Louisiana, residents getting health insurance through the Affordable Care Act’s individual exchange will see premiums drop in 2019 by an average of 6.4 percent, after years of increases.
"I'm not yet ready to say the wolf is away from the door," commented Louisiana Insurance Commissioner Jim Donelon. "It is encouraging."
But exchanges are only a small part of the larger insurance market, and cost pressures in medicine generally have not gone away.
The Trump administration continues to chip away at parts of Obamacare, and its newest initiative is allowing extensions for up to three years for short-term insurance policies that don't meet ACA's coverage requirements.
This initiative is getting a lot of pushback, though, because of fears it erodes popular provisions of Obamacare — such as exclusions for pre-existing conditions, or sharply limited payouts for people with catastrophic illnesses. A policy that does not protect the insured is not ultimately in the interest of the insurance industry, for the long term, and many worry that the new plans might be attractive — until they are needed.
"Now that you’ve got these short-term plans that don’t cover the 10 essential health benefits ... you’re now comparing apples to oranges," Brian Burton, director of the Southwest Louisiana Area Health Education Center, told The Advocate. "You really need to look at these plans and see what they cover and make sure you make the most informed decision and really do your research.”
We urge not only insurers and agents on the front lines but state authorities to be prepared to help the consumer sort through options. Just as Obamacare was complex for lawmakers in 2010 — too much so — an insurance policy shot through with exclusions might well be too complex even for informed consumers. It is vital that consumers ask what they're buying, and whether coverage will be there when they need it.