Win or lose, Obamacare has changed the game

A moment that produced lasting, beneficial changes to the health care system.
A moment that produced lasting, beneficial changes to the health care system.
Associated Press

The past few Monday mornings, at 10 a.m., those of us who obsess over such things wait with bated breath to see if the Supreme Court’s ruling on the Affordable Care Act has been issued. Obviously, it hasn’t happened yet.

But there’s still plenty of “Obamacare” news, and some of it’s rather encouraging. We’ve seen, for example, a growing number of Republicans who’ve fought to kill the law grudgingly concede they intend to keep many of its most popular provisions around. This week, we also learned that some of the nation’s largest insurers will leave in place many key Obamacare benefits, even if the Supreme Court destroys the work that’s already been done.

United Healthcare, which covers about 26 million people in plans that could be affected by the regulations, was the first to make the move. The company said it would allow young adults to stay on their parents’ policies up to age 26, wouldn’t reinstate lifetime limits on coverage and would continue to offer cancer screenings and other preventive services without co-payments. It also would maintain a third-party appeals process for treatment denials and wouldn’t cancel policies retroactively.

Later Monday, Humana said it would continue those same provisions. Aetna, too, said it would retain the young adult provision, the preventive care benefits and a third-party appeals program. Aetna’s announcement didn’t include a reference to lifetime limits on coverage or retroactive cancellation.

The continuation of these policies will bring peace of mind to millions of Americans. Even if the Republicans on the Supreme Court kill every letter of the law, and bring the entire health care system back to the dysfunctional mess we had before March 2010, key elements of the Affordable Care Act will remain in place – with the GOP’s and insurers’ blessing – leaving the country in a better place than we were before.

Indeed, it’s not just the insurance companies. Obamacare also brought reforms to hospitals that have changed the way they do business, and these measures will also remain intact no matter what Republicans do.

As it turns out, GOP lawmakers, many of whom are worried about a public backlash if millions of Americans start losing benefits they’ve come to want and expect, see these developments and take comfort. “See?” Republicans are effectively arguing, “we don’t need the reform law after all.”

That’s where they’re wrong.

Jonathan Cohn had a smart piece on this today, explaining that the recent steps from insurers and GOP policymakers don’t negate the need for the law.

[T]he insurers and their Washington representatives have been very clear about one provision they will not be preserving on their own: Coverage for children with pre-existing conditions.

The insurers also won’t be putting in place the much larger reforms to come in 2014: Federal subsidies, so that people buying insurance on their own get assistance as long as they are making less than four times the poverty line; guaranteed coverage, at uniform rates, for adults regardless of pre-existing conditions or medical risk; expanded eligibility for Medicaid, so that anybody making less than 133 percent of the poverty line can get coverage directly from the government; minimum benefit standards, so that nobody discovers their policy doesn’t cover basic treatments; and many others.

They aren’t doing any of these things because, as a practical matter, they can’t. All of them require fundamental, structural changes to the insurance market, along with government subsidies (with the cuts and revenue to finance them). Only comprehensive health care reform, like the kind the Affordable Care Act delivers, can do that.

It comes as something of a relief that some key elements of Obamacare will endure, but that doesn’t make the other elements disposable. The country still needs the Affordable Care Act, and if it’s killed – either by Republicans on the Supreme Court this year, of Republicans in Congress next year – the setback for the American system will be enormous.

Postscript: In the Politico piece linked above, Rep. Jo Ann Emerson (R-Mo.) was quoted saying, “There is plenty of room for solutions in the private market, and a primary objection to the ACA remains the heavy-handed, bureaucratic approach, which necessarily compels millions of employers and beneficiaries to leave private insurance in favor of a public option.”

Emerson was in Congress for the entire debate over health care, she was a member of one of the principal committees that wrote the House bill, and she still hasn’t bothered to learn what the reform law says or does. There is, for the record, no public option, though I wish there were.

Affordable Care Act and Obamacare

Win or lose, Obamacare has changed the game