Imposing the Affordable Care Act (ACA) in a domestic economy with diminishing buying power will be a challenge at best, but we’ll have to try. It’s predicated on the younger and healthier voluntarily signing in to pay for something they won’t likely need soon. Many don’t have jobs that pay them enough to cover anything other than basic expenses.
The last great demographic experiment like this was the introduction of IRA accounts in the 1970s. It was an exhortation to young people to put aside today’s earnings for tomorrow’s expenses and it was completely voluntary. Those without well-paying jobs would have to wait maybe a decade or two before they had the disposable income to begin to put aside, but many eventually did do so because of the immediate tax benefits.
The financial market didn’t exactly trumpet the fact that wide participation would inject a monster intravenous infusion into the arm of mutual funds and the stock market, but it certainly did. We had a lot of healthy growth in capital parked in vehicles in which the rising tide lifted all boats, or at least those with paying customers. Unfortunately, you can’t have high tides without low tides.
So now, two generations later at economic low tide, we’ve got many young people with little disposable income, being asked to sign up for health insurance right now. Yes, they can get subsidies, but they’ll have to do the research to find out what’s offered in their state or region, and their ability to be well served will depend on the information available in their states’ respective insurance exchanges.
Meanwhile, many insurers aren’t seeing the ACA as a shot in the arm for them, the same way the mutual funds did in the good old IRA days. They’ve been mandated to accept those with pre-existing conditions, and they’ve been doing what they still can to carve out markets favorable to them by narrowing physician networks, thus restricting access to health care.
Out-of-network surcharges have been with us for decades. When health care reform was first introduced, President Barack Obama said the ACA would allow subscribers to keep their doctors. Yes, for a price. Good luck to those with emergency health care situations who do not have the time to shop for specialists within their health-care network, or those who already have complex illnesses who may now have to change everything over.
As with everything else, the devil is in the details. We’re disgusted at the political posturing that obscures what really needs to be done to rework the nation’s health care delivery system. As has been said so often and so often ignored, it’s not access to health insurance that is the crucial issue – it’s access to health care.
