ACA: Still an Unknown Mess

There’s no way there can be a victory lap for the success of Obamacare; nor is there any way to declare it a complete failure. The fact is what was also known as the Affordable Care Act, passed four years ago, has been been changed 30 times by executive order mostly postponing mandatory aspects of it.

Declaring that 7.1 million have signed up is as false as the lies that “if you like your plan, you can keep it.” It sounds good, almost too good, and based on past declaration there’s no reason to believe it. That’s not supposition. Sign ups on the web site,, don’t mean anyone has paid the premium. That’s number one. Second, there’s no record, at least now, whether these are people who already had an insurance policy or, if they did, that it is any better than their old one. Third, there’s no announcement yet whether these sign-ups are the young people that are needed to make the system work.

On the other hand, let’s face other facts: someone benefits. It has (or will when used) done someone some good. Someone who didn’t have a policy before has one now; someone got a policy less expensive than one they had; someone got covered who wasn’t before. In that latter category are those who, because of pre-existing conditions, couldn’t get a policy and some who, under age 26, are now are covered by their parents’ policy. Those are popular aspects and supported by both political parties.

However, we also know that Obamacare has been disruptive. It was passed on a parliamentary procedure and without support or even input of congressional Republicans. The President and his advisors deliberately lied about aspects of it. The rule that employes working 30 or more hours must be covered, has disrupted employment. Mandatory coverages have driven up costs for some plans. Health care providers have hundreds of new rules to abide by and there are thousands and thousands of pages of new regulations.

Executive changes to the plans, including  exemptions for some political friends, has created controversy and uncertainty. Supreme Court rulings further confused the picture and we don’t know whether the IRS, the enforcement agency, will or can enforce penalties. The initial roll-out was a disaster and the system is still not completely functioning. Moreover, the numerous delays of implementation mean that the effect is unknown. Nor do we know the ultimate cost to the taxpayers or to the insurers. The effect of numerous other taxes included in the law are still unknown. Ignored in most of this is the purpose of the law. That was to get more health insurance coverage for more people.

So, here’s a little formula to consider: Total paid for sign-ups on the insurance exchanges plus those signed up for the expanded Medicaid programs minus those who already had insurance, but were forced to sign up on the exchanges equals the net number of newly insured people divided into the gross cost of promotion, administration, and subsidies equals the net per capita cost of the ACA at this given point in time.

Proof or validation comes in a broad counting of the number of people covered by health insurance before the implementation of ACA and the total number covered now and the cost of that.  Or, the reverse of that: The number still uncovered now, compared to before. None of that deals with all the employer mandates and other aspects that have been delayed or changed either temporarily or indefinitely nor with the regulations within the medical care delivery system.

Finally, this all takes repeal out of the discussion. Repeal talk should be replaced with overhaul because it is the only option and it already started with 30 executive (and therefore arbitrary and non-permanent) changes.

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