Row the Boat

From the Kaiser Family Foundation website

So, it’s been four years of a Republican administration and congress vowing to “Repeal and Replace” then “Repeal”, then “Let’s Beg the Courts to” deal with the great abomination they perceive the Affordable Care Act to be. But, I guess, elections have consequences. Now we have a Democratic administration and congress. Are they doing anything? Let’s look.

You remember I have written about the problems with the ACA before. When Nancy Pelosi said “We have to pass the law to find out what’s in it” she wasn’t kidding. There have been lots of quirks.

There is this thing called the “Subsidy Cliff”. It affects some people who purchase insurance on the exchanges (about 10% of Idahoans). Most Idahoans get health insurance through their employment (about 50%). Then there’s us Idaho geezers on Medicare (about 15%) and the poor or disabled on Medicaid (another 15%). Approximately 10% of Idahoans are uninsured (2019 numbers). You see, everybody is in a different boat. The single payer folks think this would be easier to fix if we were all in one boat. It would sure be a big boat.

But some of the folks in the Idaho Exchange boat are getting juiced. They face the subsidy cliff. Currently, if you make less than $50K and you buy your insurance on the Idaho Exchange, your premium comes to about 10% of your income. If you make $55K, the premium percentage jumps to about 20% of your income. It doesn’t make sense that a $5K raise would actually cost you $5K more in health insurance, but that’s how the current set up is.

And just like he promised, Joe Biden proposes to address this. He campaigned on fixing the problems with the ACA. Remember, lots of Democratic presidential candidates raised their hands to “Medicare for All”. But we got Joe.

The current $1.9 Trillion Covid relief budget reconciliation bill has “a fix” for this subsidy cliff. If it passes both houses (passed the Senate this weekend, maybe House on Tuesday), this cliff will disappear. Instead, folks buying insurance on the exchange will see gradual increases in the percentage they pay as their incomes go up, not the steep jump.

Here’s the catch. It’s only a two-year fix. Unless it is continued, in two years, the cliff comes back. What else happens in two years? Yup, mid term elections. The House will probably go back to the “Repeal” crowd and nothing will be done awaiting another presidential election.

It’s our fault folks. We don’t demand our elected officials address the health care mess in this country. We can’t stay focused on a problem longer that it takes to watch a Tick Tock or read a tweet. And if we can’t, we sure can’t expect our elected officials to have that discipline.

This fix has been in a lot of congressional drawers for four (maybe ten!) years getting no discussion, no traction. We, the splintered masses, have not asked for this simple fix with any sort of voice that could be heard.

It makes sense, given the many boats we are in. This problem probably affects about 1-2% of Idahoans, and about the same percent nationally. That’s not a large electorate, even for a simple fix. Especially when all you have to say is “Obamacare” and the AR15s come out.

Yes, it’s our fault. But it is a very complicated law, that ACA, Obamacare thing. There are lots of folks paying attention to it with ideas and suggestions. But we sure don’t want to hear any of that, do we?

Maybe, the scream and Tweet crowd would rather we have a simpler system, one where we are all in the same boat? If we don’t do the work to fix the many little boats we are in, we’ll all be swimming soon enough.

About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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