The statistics are encouraging, with officials announcing this week that the number of Washington residents who don’t have health insurance has been cut in half under the Affordable Care Act.
Yet, the overriding question remains: At what cost?
In June 2013, Gov. Jay Inslee approved a budget allowing for the expansion of Medicaid in Washington. That expansion, combined with the state’s health care exchange and a provision that allows people younger than age 26 to remain on their parents’ insurance, has resulted in more and more Washington residents having health insurance. In Clark County, the uninsured rate has dropped from 14.7 percent in 2012 to 8.7 percent; the statewide rate is 8.3 percent.
That was one of the primary goals of the Affordable Care Act — to help people procure insurance. Financially, this makes some sense, as the uninsured are more likely to use emergency rooms as an urgent care service or to engage in other behavior that eventually passes the costs along to others.
At the same time, characterizations of Medicaid as free health coverage for the poor is a misnomer. Medicaid is paid for by taxpayers, amounting to subsidized health care for those who collect from the program. Nearly one-quarter of the federal budget goes to health care programs — Medicaid, Medicare, the Children’s Health Insurance Program and the Affordable Care Act. Medicaid expansion is far from free for those who are working and paying taxes.
In other words, the costs of the Affordable Care Act should continue to be subject to critical examination — and there is no shortage of critics willing to do this. As Sally Pipes wrote last year for Forbes: “President Obama sold his law as a means to spare people from ‘double-digit premium increases year after year.’ Instead, his ‘inartfully’ named — and drafted — Patient Protection and Affordable Care Act has made the situation worse, with insurers asking for the double-digit premium increases the president promised to do away with.” Many private insurers have, indeed, sought large premium increases as the industry adjusts to the changes brought about by the Affordable Care Act.
And yet, only the most cold-hearted of critics would not view an increase in the number of insured citizens as a benefit. The United States’ health care system, often disingenuously proclaimed to be “the best in the world,” in truth has been an embarrassment. A 2014 survey by the Commonwealth Fund — using numbers from before the Affordable Care Act went into full effect — ranked the U.S. last among 11 wealthy nations in terms of “efficiency, equity and outcomes.” In 2000, the World Health Organization ranked the U.S. care system as the 37th best in the world, despite ranking first in per-capita spending.
All of this can be confounding for taxpayers. The American health care system was in need of attention; the Affordable Care Act has provided some imperfect improvement; and Republicans in Washington, D.C., have put forth demagoguery rather than solutions. Rather than labor to make the Affordable Care Act workable and truly affordable, Republicans (including Rep. Jaime Herrera Beutler, R-Camas), have simply attempted to scuttle the program.
With health care promising to be a signature issue for this year’s presidential election — and Congressional elections — this approach is unacceptable. The number of newly insured people proves that the Affordable Care Act is rife with success stories, but there is plenty of room for improvement.
