Why ACA Has Become Politically Irrelevant in the 2012 Campaign

Why did the health care debate in this year’s election campaign pivot so quickly from the Affordable Care Act to Medicare?

It may well be because of this:  While people still feel strongly about ACA, they don’t really see it as relevant to them.  But Paul Ryan made Medicare relevant to everyone when he proposed changing the program for the under-55 population.

Some new data from the U.S. Census Bureau may explain why most people don’t see ACA as relevant to them.

We learned this month that the number and percentage of people without health insurance changed modestly in the year after ACA passed.  The number of uninsured people went from 50 million to 48.6 million.  The percentage of uninsured decreased from 16.3 percent to 15.7 percent.

These changes were small, as were some others.  The percentage of people with employer-based insurance decreased slightly, from 45.7% in 2010 to 45.1% in 2011, and the percentage of people who purchase private insurance directly remained the same, at 3.6%.

Despite rumors of a “government takeover” of health insurance, government programs also experienced modest changes.  The Medicaid population grew from 48.5 million, or 15.8% of the population, to 50.8 million, or 16.5%.  Medicare recipients grew by 2 million, from 44.9 million people (14.6%) to 46.9 million people (15.2%).   

And the populations experiencing the biggest gains because of ACA aren’t very big when compared to the population as a whole.

• Nearly 3 million young adults under the age of 26 are covered on their parents’ insurance plans as a result of ACA, but they represent less than 1% of the population – and some were already on their parents’ plans before ACA passed because they were still in school.
• Approximately 3.6 million Medicare donut hole recipients saved drug money in 2011 because of ACA, but they also represent only about 1% of the population – and they were already on the Medicare program anyway.
• 4.5 million early retirees remained on employer plans after ACA – but many of these had been on those plans anyway; it was the plans that became eligible for financial relief under ACA.
• Approximately 13 million people got insurance rebates because of ACA in 2012, but many of those rebate dollars were credited to employers, not to individuals.  Perhaps another 1% of the population – one third of those covered by individual insurance only – actually received the full value of the rebate in the form of a check.

These numbers are just big enough to elicit a yawn from more than 95% of the population.

And most of us may keep yawning in the future.  According to 2012 data from the Center for Medicare and Medicaid Services, the percentage of our nation’s health care bill paid by private insurance in 2011 was 34%.  The percentage private health insurance will be paying in 2021, after ACA is fully implemented, will be 33%.

Just as ACA changed the political landscape in 2010 because of how much people worried about what it might do, it may have little effect in 2012 because of how much it hasn’t done.

And even after ACA is fully implemented in 2014, many of us might not notice.  Up to 30 million uninsured people may gain insurance – an extraordinarily significant number – but they still represent less than 10% of the population.

When you add it all up, here is one way to quantify the change to which we can look forward.

Out of every 20 people today, 9 have employer-based insurance only, 1 has individual insurance only, 3 are on Medicare (sometimes in combination with Medicaid), 2 are on Medicaid alone, 1 has another type of government plan, 1 has a combination of coverage, and 3 are uninsured. 

When ACA is fully implemented, in that same group of 20 the number of people purchasing insurance directly will eventually increase from 1 to 2, the number on Medicaid will increase from 2 to 3, and one will still be uninsured.

That’s it.

That’s why the campaign debate has pivoted to the future of Medicare.  

When Paul Ryan proposed making changes to Medicare that affect the under-55 population and when Mitt Romney chose him was his vice-presidential candidate, they took a program that until now has mattered mostly to the 55+ population (Medicare and near-Medicare recipients) and made it relevant to everyone.

And just like that, the political landscape shifted.

If you have questions about this column or wish to receive an email notifying you when new Our Health Policy Matters columns are published, please email gionfriddopaul@gmail.com.

Haley Marie is Born

I am writing this column just a few hours after the birth of my second grandchild, Haley Marie.  Haley Marie looks like her father.  She is long and thin, and she is going to be very pretty when she is older.

Our first grandchild, Noah, was born four months ago.  He’s in the 5^th percentile in weight, and my wife and I joked that it would be hard for Haley to beat that when she came along.

She did.  She weighed in at two pounds and eleven ounces, which means that, according to the Annie E. Casey Foundation Kids Count project, she is one of the 1.5% of all U.S.  babies who are born each year at “very low birth weight,” or less than 1500 grams (3 pounds, 4 ounces). 

So Haley Marie will spend her first days in a hospital neonatal intensive care unit. 

Haley is fortunate.  She was beyond thirty-two weeks of gestation.  Her Apgar scores were stellar.  She is strong and has good lungs.  I can also offer direct testimony that she is alert and responsive to light.  I learned this when I snapped a picture of her at five hours without turning my camera flash off!

But not every baby born at very low birth weight gets off to as good a start as Haley.

We all say we care for babies, but here is something we don’t like to mention:  low birth weight babies have a higher risk of dying.  Very low birth weight babies have a 24% chance of dying during their first year of life.

I’m a worrier by nature.  So statistics like this have always worried me.  Even before there were children and grandchildren in my life back when I was a state legislator, I stressed constantly over how to help reduce our too-high infant mortality rates.

Prevention and good prenatal care are answers.  But sometimes – as in Haley’s case – a baby is born at low birth weight even though her mom has taken good care of herself during pregnancy and received high quality prenatal care.

Neonatal intensive care, thankfully, is another answer.  But neonatal care is expensive. 

In 2005, the Institute of Medicine found that most of the $26 billion annual cost of premature birth  - or over $51,000 per child – was for neonatal intensive care.  Haley’s parents can’t afford this, nor could most of us.

Thank goodness we have insurance to pick up the slack.  But relying on private insurance to pay our neonatal intensive care bills is a double-edged sword.  Insurers often charge hefty co-pays, and the amounts can change unpredictably.  As Michelle Andrews pointed out in an article in Kaiser Health News in January, 2011, “fewer parents-to-be realize that they may be in for a nasty surprise if their baby is premature or for some other reason needs special care immediately after birth: The neonatal intensive care unit (NICU) personnel at their in-network hospital may be out-of-network.”

Here’s something that may offend some people, but I’m going to write it anyway:  Relying on private insurance alone to pay for health care is too big a gamble when children’s lives are at stake. 

It’s a good thing many children have the security of a public option, too.  Shame on the politicians who say they have a problem with this, and want to roll back or block grant Medicaid or SCHIP funding at Haley’s expense.

They have never walked in her tiny shoes; I hope they never even have to walk in mine.

The NICU providing care to Haley today was also built in large part through the investment of hundreds of millions of taxpayer dollars beginning fifty years ago.  I’ve lost faith that the “tax cuts at all costs” politicians of today would have the backbone to launch a similar project.

And for this Haley’s granddaughter could someday pay a price.

As a group, children born at very low birth weight face more challenges as they grow up.  According to Child Trends, they are more likely to have chronic health conditions and developmental delays.  They are also more likely to need special education services.  They are at greater risk of dropping out of school, and have lower earnings potential.

I’m not going to think about all this today, however.

Haley, I am sure, will be just fine.  So I’m just going to celebrate the miracle that is her life.

And acknowledge with gratitude the governments that protect us all, especially those, like Haley, who are most in need.

If you have questions about this column or wish to receive an email notifying you when new Our Health Policy Matters columns are published, please email gionfriddopaul@gmail.com.

Please Vote for the Mental Health Association of Palm Beach County in the Chase Community Giving Campaign before Sept. 16th.  It just takes a couple of minutes to help win dollars for programs that prevent mental illness in children.  Click here to vote http://bit.ly/VoteMHA