There’s much confusion, conflation, and outright nonsense out there about “Obamacare” and the implications and effects thereof, most of it based on a lack of understanding, and a lot of that seemingly willful.
This was brought home in recent conversations with friends; one on the board of a local hospital here in upstate New York, another who is close friends with a brand-new neurosurgeon, a third a child psychiatrist in the South.
The general issue is simple: every problem – great, small; clinical, financial, or administrative; access-, process-, or outcome-based; that involves health insurance, health plans, governmental programs is blamed on Obamacare.
That asteroid coming within a mere 745,000 miles? Damn Obamacare!
The Ukrainian war? Due to Obamacare!
My kid didn’t get into the elite kindergarten? Obamacare AGAIN!
Ok, a reality check…
First, while some facilities are shutting their doors, hospitals have been closing for decades, looooong before PPACA was even dreamt of. If anything, the closure rate has declined significantly of late. That’s because the country was seriously over-bedded, a situation which led to too many inappropriate admissions. 65% occupancy rates are not sustainable and inefficient so hospitals have to either get efficient or close. Harsh as that is, we just can’t afford them. Yes, that will hurt some health systems and may well lead to access issues in smaller communities. And yes, that will lead to lower health care costs and more dollars for education, tax relief, roads and infrastructure.
More to the point, hospitals are in much worse peril in states that have not expanded Medicaid.
Second, on balance, PPACA has been good for hospitals; many are doing better these days than they were for years. In large part this is due to higher coverage rates among the employed as well as the expansion of Medicaid in states that weren’t so blinded by misplaced ideology that they refused the federal dollars.
Third, beyond the odd anecdote, there haven’t been any credible reports of increases in waiting times, access difficulty, or lack of care that can be attributed to PPACA. (notably I was told this was a big problem in Florida, a puzzlement as the Sunshiners have yet to expand Medicaid).
Fourth, cost. Health insurance premiums have gone up due to health care cost increases, not due to “Obamacare”. From a Commonwealth Fund analysis of plans with price increases >10% (insurers are required to report reasons for the increase) :
rising cost of doctor visits, hospital stays, surgeries, tests, medications and other types of direct care were responsible for 84% of the premium hikes in the individual market and 78% in the small group market (which typically includes small-company plans and others with only a minor volume discount).
Finally, PPACA’s costs continue to come down, with the latest figures indicating it will cost $139 billion less than the previous CBO estimate.
That’s $139 billion that can be spent on education, job training, infrastructure, tax relief, pre-K…
What does this mean for you?
Don’t just repeat what you hear on talk radio. It is likely wrong.