Obamacare doesn't solve North Carolina's healthcare problems

Published November 22, 2013

By Tom Campbell

by Tom Campbell, Executive Producer and Moderator, NC SPIN, November 21, 2013.

Every era has its one big issue to face. Ours is healthcare. The Affordable Care Act, or Obamacare, had two primary goals: to reduce healthcare costs, especially taxpayer support, at the same time improving health outcomes. Polls show growing numbers of North Carolinians don’t believe it will succeed.

Obamacare’s success depends on the mandate that all have health insurance. Best estimates are that 1.5 million (roughly 15 percent) North Carolinians are uninsured, about the same as national percentages. One great myth is that the uninsured do not get healthcare. They do and most get it from hospital emergency departments that by law cannot deny them, even though it is the most expensive care available. Since many cannot pay for this care, costs are shifted to those with insurance and to the public.

Obamacare postulated that by expanding those eligible to receive Medicaid and by subsidizing those unable to afford health insurance usage of the emergency department would be dramatically reduced, substituting relationships with primary care physicians providing less expensive routine and preventive care. Even with an initial increase in government support ACA advocates believed the net result would be substantial healthcare cost savings.

Let’s look at the numbers. Individuals earning less than $43,000 or families of four earning less than $89,000 per year are qualified to receive federal health insurance subsidies. In September 2013, the Census Bureau reported the 2012 U. S. median household income was $51,017. For full-time, year-round workers the median is $49,398 for men and $37,791 for women. 2011 Census data reports North Carolina’s median per-capita income was $25,256 and median household income was $46,291. Unquestionably a large cohort in North Carolina will qualify for varying subsidies.

Theories and outcomes are often different. ACA details took too long to materialize and many of the requirements make no sense and are counterintuitive. If Obamacare’s goal was for everyone to have health insurance the decision that existing policies would be noncompliant if they didn’t include maternity and other coverage was counterproductive. Postponing the requirement for businesses to insure their employees, the President’s promise not to enforce the carrot-and-stick fines for those who did not enroll and the abortive October start-up further stirred the pot, but the icing on the cake was last week’s pledge to allow non-compliant policyholders to keep their current plans another year. Adding insult to injury was the announced rate hikes of between 16 and 24 percent to those current policyholders.

North Carolinians are confused, angry and have lost confidence in Obamacare. No wonder only 1,700 signed up in October, the first month enrollment was open. 15,000 more learned they were eligible for insurance subsidies and 7,000 qualified for Medicaid.

The ACA will almost certainly fail to yield enough enrollments to produce projected cost savings; more likely is that public taxpayer costs will soar and health insurance rates for those covered will increase. And once public benefits have begun they are almost impossible to rescind. Congressional Democrats are likely to bear the brunt of public disillusionment in the November 2014 elections and, if enough Republicans win Senate seats, there is a strong chance Obamacare will be repealed. Under any scenario it will be modified.

And we still won’t have resolved the big issue of our time.

November 22, 2013 at 3:47 pm
Neal Campbell says:

Since North Carolina is funneled into the critically damaged healthcare.gov web site, the supposition that 1500 enrollees is indicative of the first enrollment period and what happens in the year after, is premature. I actually am curious how those 1500 got through the website to enroll!

The theory behind ACA isn't a postulation, its actively being used in Mass. and the healthcare costs have met the predictions. Of course, the devil is in the details and I have no idea how the implementation in Mass. differs from the federal plan, but the theory does work.

The doom merchants of Obamacare are not analysts, they are partisans who are actively trying to scare people from the program. Why is this? It cannot be because having more insured citizens is a bad thing (and in usual political irony, the plan originated from the same party that is hoping for its failure). The reason is purely gamesmanship. The evidence is in the fact that these same "freedom" activists are the once forcing women to all but name their fetuses at conception and name it. Forcing women to travel many miles to a "certified" doctor or have trans-vaginal ultrasound tests isn't an infringement nor obviously a fee that they are concerned that the citizenry has to pay.

The analysis of increased cost to existing policy owners is actually what John Roberts said it was, a tax. Sorry but you are having a tax increase. Not a crazy wild one, but an increase.

A lot of "young invincibles" will probably pay the penalty instead of get the insurance which is another area the Doom sayers are highlighting. I believe that the actual number of these invincibles enrolling for things to work is a 10% enrollment. Not 100%, not even 33% but 10%. Do you think enough of them is aware of how someone they love has been bankrupted (or worse, died) due to no coverage to provice the 10% enrollment? I think the odds are better than our Fox Fanatics believe.

The inability of the Republicans to do a single thing to make this law better means we are stuck in time with the initial bill unlike even recent history with the medicaid prescription bill passed during the last Bush's administration (and we can hope it is the last Bush administration). It also suffered from a wobbly start (admittedly not as wobbly as the current website) but things improved and its a good law.

Its just premature to make these calls.

The "non-sense" requirements for coverage that the buyer doesn't want is an inevitable concession to using the free market instead of single supplier. I view it similarly to my property tax going to build schools (that none of my family will use), sewage in areas of our county i do not ever want to live in, etc. I pay these because the greater good of the community needs it, period. The insurance companies (its hard to feel much sympathy here but I am trying..) are forced to insure people like me with pre-existing conditions that they would normally reject, pre-ACA. Sorry, that is a great "greater good" for the society. If it bumped your current plan's premium up 15 bucks, its a tax just like the school and public works part of my property tax.

Its easy to get caught up on the emotion of the moment, especially with the political environment we have, and the Republicans are doing everything possible to make voters forget the government shutdown they did during the summer as they look to the 2014 elections.

If health care is the topic of our time, implement something better before you declare this one dead.

November 22, 2013 at 10:04 pm
Tom Hauck says:

Thanks Tom,

Your points are well made and an additional point is that those with low incomes receive a subsidy to pay the monthly fee but the amount of the annual deductible is often between $3,000 and $11,000. If a person cannot pay the monthly fee, how will they pay the annual deductible?

November 23, 2013 at 4:57 pm
Tom Hauck says:

HI Tom and Neal,

Here is an interesting article by a Duke professor. It explains exactly where the ACA is not helpful to most Americans. By the way -- over one year ago -- he correctly told us of the problems that have come to light since the ACA became more well known to the public.


I am also pretty sure that the Massachusetts healthcare bill was not over a thousand pages long with 10,000 pages of regulations added to it. As you say, the devil is in the details.