Remembering What Matters About the Affordable Care Act

On the Affordable Care Act front today, there's very good practical news, and not-so-good political news. That gives us an excellent opportunity to remind ourselves to keep in mind what's really important when we talk about health care.

Let's start with the good news. First, as Marketplace reported this morning, a new report from PriceWaterhouseCoopers shows that the average health insurance premium on the exchanges is actually lower than the average premium in employer-sponsored plans. And it isn't because the coverage is inadequate; according to a spokesperson, "even when you factor in all the out-of-pocket costs, the average top tier gold and platinum plans are similar to employer ones." It's hard to overstate what a success this is. If you've ever bought health insurance on the individual market before now, you know that if you could get covered at all, you were likely to get a plan that was expensive but had lots of gaps and lots of cost-sharing. The whole point of the exchanges was to give people buying insurance on their own the same advantage of pooling large numbers of customers that you get when you're covered through your employer. If it's working, then that's something to celebrate.

Second, as Jonathan Cohn tells us, Wellpoint, one of the nation's largest insurers, is reporting that exchange sign-ups are meeting their expectations; they have 400,000 new customers, and expect the number to rise to a million by the end of open enrollment. Even more critically, although their new customers are slightly older than the population as a whole, they expected this because people with a more pressing need for insurance would be the first to sign up, and they already incorporated that into their rates for this year. That means they're unlikely to lose money, there is unlikely to be a huge rate spike next year, and the dreaded "death spiral" looks less and less likely.

This supports the contention I've had for some time, that in its first few years the Affordable Care Act is going to basically be fine—it may not create a health care paradise, but nor will it be the disaster conservatives are so fervently hoping for.

Before we get to sorting through what matters from what doesn't, let's look at the not-so-good political news. The Kaiser Family Foundation is out with their latest health care tracking poll, and there isn't a lot to be glad about. More people have an unfavorable than a favorable view of the ACA. Most Americans are unaware that almost all the provisions of the law are now in force. And maybe most troubling, nearly half of Americans are still unaware of the law's most popular provision, that insurance companies are no longer allowed to discriminate against people with pre-existing conditions:

Before you say, "Obama should have told people about it!" I must remind you that during the last four years you spent away from Earth, the administration and its allies did in fact repeat over and over and over again that the ACA prohibits insurance companies from denying you coverage if you have a pre-existing condition. There are many reasons why so many people haven't yet understood, but you can't say they didn't try (you can read more about the myth of the bad sales job here).

In any case, here's what we have to remember: On the scales of history, a person with a pre-existing condition who gets health coverage weighs much more than a person who doesn't know that because of the ACA, people with pre-existing conditions can get health coverage. We spend so much time talking about politics that it's easy to forget that politics are not an end in themselves, they're a means to an end. Liberals advocated for comprehensive health insurance reform for so many decades not because it was politically advantageous (at some times it was, and at other times the voters didn't seem to care), but because it was right. The fact that so many millions of Americans had no health security up until now was a moral obscenity. The ACA is beginning to fix things—slower and less completely than we might like, but it is a beginning. And if it never becomes the political boon you were hoping for, it was still the right thing to do.

That isn't to say that political effects don't matter, because they do. If the Republicans take over the Senate this fall, bad things would result, particularly if they also win the White House two years later, and if the ACA's political troubles contributed to that turn of events, it would be unfortunate. But in the long run, what matters most is the effect on Americans' lives. When you get distressed by a story about a Democratic member of Congress who's in a tough race where her opponent is hitting her for supporting Obamacare, you can think of the families who never had health coverage before, but do now. For millions of people it will life-changing, and for many, literally life-saving. Try not to forget.

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