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Saturday, December 21, 2013

Obamacare: Notches and Fixes

It was predictable that Obamacare would create losers as well as winners.

The New York Times reports:
“We are the Obama people,” said Camille Sweeney, a New York writer and member of the Authors Guild. Her insurance is being canceled, and she is dismayed that neither her pediatrician nor her general practitioner appears to be on the exchange plans. What to do has become a hot topic on Facebook and at dinner parties frequented by her fellow writers and artists.
“I’m for it,” she said. “But what is the reality of it?”
In social welfare policy, a "notch effect" occurs when a small increase in income triggers a big decrease in eligibility for benefits.  The New York Times describes the Obamacare Notch, focusing on the Chapmans, a family not poor enough for subsidies, but not rich enough to absorb premium hikes painlessly.
An analysis by The New York Times shows the cost of premiums for people who just miss qualifying for subsidies varies widely across the country and rises rapidly for people in their 50s and 60s. In some places, prices can quickly approach 20 percent of a person’s income.
Experts consider health insurance unaffordable once it exceeds 10 percent of annual income. By that measure, a 50-year-old making $50,000 a year, or just above the qualifying limit for assistance, would find the cheapest available plan to be unaffordable in more than 170 counties around the country, ranging from Anchorage to Jackson, Miss.
While the number of people who just miss qualifying for subsidies is unclear, many of them have made their frustration known, helping fuel criticism of the law in recent weeks. Like the Chapmans, hundreds of thousands of people have received notices that their existing plans are being canceled and that they must now pay more for new coverage.
In an effort to address that frustration, the Obama administration announced on Thursday that it would permit people whose plans had been canceled to buy bare-bones catastrophic plans, which are less expensive but offer minimal coverage. Those plans have always been available to people under 30 and to those who can prove that the least expensive plan in their area is not affordable. But the announcement does not address the concerns of those who would like to buy better coverage, yet find premiums in their area too expensive.
At The Washington Post, Ezra Klein explains problems with this move:
[T]his puts the administration on some very difficult-to-defend ground. Normally, the individual mandate applies to anyone who can purchase qualifying insurance for less than 8 percent of their income. Either that threshold is right or it's wrong. But it's hard to argue that it's right for the currently uninsured but wrong for people whose plans were canceled.

Put more simply, Republicans will immediately begin calling for the uninsured to get this same exemption. What will the Obama administration say in response? Why are people who plans were canceled more deserving of help than people who couldn't afford a plan in the first place?

The same goes for the cheap catastrophic plans sold to customers under age 30 in the exchanges. A 45-year-old whose plan just got canceled can now purchase catastrophic coverage. A 45-year-old who didn't have insurance at all can't. Why don't people who couldn't afford a plan in the first place deserve the same kind of help as people whose plans were canceled?