Thanks, Obamacare

One of the more amusing highlights of President Barack Obama's campaign appearance in Philadelphia this week on behalf of Hillary Clinton was his use of the phrase, "Thanks, Obama," to brag about his accomplishments in office — even adding $2-a-gallon gasoline to the list after someone in the crowd happily reminded him. The irony, of course, was that his political opponents have been using the same phrase for years in a sarcastic effort to assign blame for most anything they perceived to be wrong about the country.

Well, here's an addendum: It's past time Americans started saying, "Thanks, Obamacare," to recognize the success of the Affordable Care Act. And it's not just the millions of people who now have health insurance who couldn't get it in the past — whether because they couldn't afford it or perhaps had a pre-existing condition that made it impossible to purchase — who should be grateful. It's the millions who have seen significantly lower increases in health insurance premiums in recent years who should be happy that the much-maligned law is on the books.


The ACA's successes seem to get lost in the shuffle for two reasons. First, because health care reform has become so politicized, particularly in Washington where Republicans in Congress have voted to repeal the law something on the order of 60 times. Terrorists don't suffer that many negative votes on Capitol Hill. But second, because an obvious problem has arisen that's received a disproportionate share of attention — the manner in which the individual market is out of whack, with rising premiums and insurers dropping out of exchanges.

That's a legitimate concern, of course, but it's one that needs to be put in perspective. The vast majority of Americans get their health insurance through employer-sponsored group plans, not the individual market, and those plans have remained relatively stable in coverage and rates. In Maryland, as The Sun's Andrea K. McDaniels recently reported, average premiums grew by just 3.4 percent this year. Had the ACA not existed, premiums would be far more costly — about $1,300 per family more in 2015, by one estimate.


Why? Because prior to the ACA, premiums were growing at a brisk 10 percent annual clip. Since the law's passage, there's been a downward pressure on prices — there's more competition, more government oversight on rates, a cap on what insurers can charge for overhead as well as risk-abatement for insurers (so they can't suffer catastrophic losses). That doesn't mean rising health care costs are licked (out-of-pocket costs to consumers are a whole different issue), but it certainly means there's been progress.

But let's also not forget that far more people are insured today than before. In Maryland, the percentage of uninsured has dropped from 11.3 percent of the population in 2010 to 6.6 percent in 2015. One result is that people are getting healthier (and are less likely to end up bankrupted by medical costs). Meanwhile, the Centers for Medicare and Medicaid Services report that Maryland's Medicare-related hospital readmissions have dropped more than 10 percent since 2010, another sign that health (and health care) is improving.

Obviously, the individual market needs to be fixed. The state's insurance regulators are already looking at premium increases of as much as 20 percent to 30 percent for next year in that segment of the market where competition has been shrinking as carriers lose money. Overall, the country needs to find ways to make health care more affordable for everyone. We spend far more and get far worse outcomes compared to other countries, and the middle class (who aren't eligible for Medicaid) have taken the biggest hit.

That doesn't make Obamacare the disaster its opponents claim, it means the ACA was a starting point in rescuing the private insurance market that was spiraling out of control. If Congress could somehow get past the partisanship, there are any number of possible fixes — make more middle class workers eligible for ACA subsidies, for instance, get more states to expand Medicaid eligibility and create a "public option" that provides Medicare-like coverage for people who are younger than 65. Such reforms could lead to better and more affordable coverage for millions more Americans while maintaining health competition in the marketplace and a cap on rate increases. That's a win-win-win that even the most hard-hearted partisan ought to embrace.