O Bamacare, O Bamacare, How Long Will You Sur-vi-ive?

Rumors of Obamacare’s demise are greatly exaggerated.  It took a hit from the tax bill Congress just passed, but the health insurance program is still on the books.  The just-completed enrollment period reached 96 percent of the enrollment from last year despite the period being half as long and the advertising budget being slashed.  Enrollment was also surprisingly strong given the rise in premiums in many areas of the country. The expanded Medicaid benefits in many states are also still in place.

Premiums are rising for various reasons.  One reason is structural problems with Obamacare that could be fixed by Congress if a majority wanted to.  Another reason is that health insurance premiums have been rising every year for decades.  A third is the uncertainty insurance companies have to deal with when they set annual rates for Obamacare plans.  Insurers don’t like uncertainty so they price it in.  They have not known from month to month if the White House will continue to make the payments to them that help them provide discounts to low income Americans, or if Congress will pass legislation that solves that problem for them.  The Congressional Budget Office (CBO) estimates that premiums for silver plans will rise 15 percent in 2018 simply because of this uncertainty. 

The tax bill ended the individual mandate, the penalty for those who do not have health insurance from Obamacare or any source.  CBO estimates that this will result in 13 million more people being uninsured by 2027 than under the individual mandate, and that insurance premiums will rise ten percent for all people in the individual market (not just Obamacare) because it will have fewer younger, healthier participants.   But the loss of younger, healthier people will definitely be a problem for Obamacare, likely exacerbating the rise in premiums. 

Obamacare helps counselors by providing insurance for low income Americans through the insurance exchanges, by ensuring that preexisting conditions including mental health issues do not preclude people from finding insurance, and by requiring that Obamacare policies cover mental health.  Obamacare has also made mental health treatment available to millions of low income people through the expansion of Medicaid benefits.  Prior to the implementation of Obamacare requirements, 38 percent of individual plans did not include mental health benefits. 

It is not yet clear whether further attempts to repeal the entire program will be on the Congressional agenda in 2018.  Some members of the majority believe they could be successful with a different approach, such as scrapping Obamacare and sending most of the money it costs to the states in health care block grants.  This idea was gaining traction last summer before Congress decided to turn to tax legislation.  Others believe that it would be more productive to work on a bill that stabilizes Obamacare’s finances, or an infrastructure bill, or something else that can get bipartisan support.  The political calculations change in an election year. 

The American Counseling Association will continue to represent the interests of counselors as Congress considers Obamacare and other healthcare legislation.