The Problem with Maintaining Popular ACA Provisions by Nicky Riordan
President Trump identified his healthcare priorities this week before Congress. In doing so, Trump took a few steps to the left, while committing to the fundamental notion of repealing and replacing Obamacare.
A few major provisions have managed to garner bipartisan support in the ongoing secret, and not so secret, GOP development of healthcare policy. One of these provisions allows young adults under the age of 26 to remain on their parents’ plans.
This provision was one of the first to take effect and had an immediate impact. In 2010, those between the ages of 18 and 25 had the highest uninsured rate among non-elderly adults. By 2015, that rate had decreased by 52 percent, and coverage was not similarly affected among adults 26 to 35.
Though popular, this provision may be partially to blame for the explosion of marketplace premiums. Initial gains in this age group have leveled off over time and the availability of dependent coverage in an adult’s healthiest years have left non-group plans with higher risk pools and higher premiums.
Much of the current criticism of the ACA’s rising premiums and marketplace collapse are attributed to a failure of the Obama administration to attract enough young people to offset costs of expanded coverage. By removing so many young adults from the individual marketplace altogether, the potential for a successful system under this model is undermined.
The current Republican proposal to keep this provision and reduce cost for young adults by replacing the price ratio with a tax credit is flawed. Young adults will still not be sufficiently transitioned into the individual marketplace.
A second provision that President Trump publicly supported on Tuesday night was protections for people with preexisting conditions. This has long been a policy priority for Democrats and has become too politically difficult for Republicans to oppose, particularly in light of recent town halls involving personal stories of constituents who claim their lives have been saved by this provision.
Equal access and financial burden are two separate issues when it comes to preexisting conditions. The Republican replacement plan aims to recreate “high-risk pools” and a continuous coverage incentive to ensure that everyone can remain covered. This step backward will render many low-income and middle class families unable to afford insurance under this model. Moreover, even a slight gap in coverage will allow insurance companies to skyrocket premiums.
These two provisions demonstrate how each party is reluctant to disavow politically popular policies in the ACA. This is good, because voters are keeping members of Congress accountable, but citizens should not be content with any reform or repeal that fails to address underlying problems in the initial bill or healthcare at large.
Nicky Riordan, M.A. Peace and Justice Studies, is Public Policy Manager at Feeding San Diego.