Guest opinion: Congress should fix ACA, not kill it |

Guest opinion: Congress should fix ACA, not kill it

Donna Yost

I just read Bryan Whiting’s column about how bad the Affordable Care Act (Obamacare) is and how it needs to be replaced. The biggest reason is the cost of insurance, which has gone up astronomically the past two years. What you don’t report is why this has happened.

I was covered by Colorado Health Op. This was a low-cost nonprofit co-op for health insurance through the insurance exchange. It competed against the big private insurance companies and probably helped keep prices down.

So what happened? In the fall of 2015, the Centers for Medicaid and Medicare Services reneged on reimbursement promises that were made through the risk corridor program with the ACA. This was established with the understanding that setting premiums for previously uninsured or underinsured to higher standards of coverage was risky business for insurance companies. This included such things as no longer being able to deny coverage based on a pre-existing condition.

So the first three years of the ACA, the federal government promised to help insurers accept that risk by paying companies whose claims exceed premiums and collecting from those whose fell short. But that cushion (protection from risk) went away when the Centers of Medicaid and Medicare Services announced insurers would see only 12.6 percent of what they were entitled to under the program.

Note: This method of dealing with health insurance companies has been done before successfully. That was with Medicare’s drug benefit during the Bush years. Competition in this program is vigorous, rates are competitive and lower than expected and participants are satisfied. Hmmm … I wonder what the difference is here between Obamacare and the Bush drug plan? But let’s continue.

Colorado Health OP was expecting $16.2 million — instead it got $2 million. And therefore the “rainy day” fund didn’t meet minimum requirements set by the Department of Insurance. Independent projections had the co-op on track to be profitable in 2016 and be capable of having enough of a profit to start paying back federal startup money ahead of schedule.

On top of this, the American taxpayers were stuck with a $40 million bill for the early closure of this insurance company that could not now repay the loan, where if $16.2 million had been invested — as promised — it would have come back to the government rather than paying out $40 million by closing it prematurely.

Colorado Health Op went out of business. The other insurance companies — which also were depending on these payments — either chose to get out of the pool of insurers or raised their rates by 20 percent or more even though medical costs went up about 5 percent this past year. Why? To cover the additional risk they just took on by remaining in the individual market since the government reneged on its promises.

Now who, you are probably asking, was responsible for this fiasco? Who was in charge of this? Well — the Republicans have been in control of Congress for the past six years. During those six years they have voted over 60 times to repeal the law, even though they knew the act was fruitless with President Obama in a position to veto the bill.

But they could have presented, debated and voted on a replacement or fixes to the act. President Obama said he was very open to anything except simple repeal. They did neither in all this time. But they do hold the purse strings, and they were able to start strangling the means that would make the plan work.

Insurance companies raised rates because of the additional risk they had not originally factored in, along with the political uncertainty.

So what do you think is going to happen if the Republicans pass a “repeal and delay” bill? Do you think the insurance companies are going to feel any better about their degree of risk in this market? Hardly. The risk is almost unknowable, and they will flee from the exchanges like rats from a sinking boat.

If Congress thinks this will keep everything status quo for the next year or two they are even stupider than I thought. Besides the fact they have had six years to come up with an alternative and haven’t, do you really think they will come up with one in the next year? This will end in chaos. People will be thrown out of insurance they now have. The rest will be paying even more. And the possibility of just working with something that is in place to fix the inequities and other issues will be gone.

We need to stick with what we have, and fix what is wrong. And the next thing to work on is why our medical care is so expensive to begin with and try to fix that — if costs go down, insurance rates should go down.

As Hal Sundin stated in his column last week, the 10 pharmaceuticals in the Fortune 500 earn more profits than the other 490. It is not like you can treat medication like a car — “that car is too expensive — I’m not going to buy it.” Or any other part of your health care. It is not a choice, it is a necessity, and one party wants us to submit to the free market for our health care. How do you feel about corporations getting rich off your health?

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