Editorial: On Affordable Care Act, we can’t turn back the clock
Former U.S. senator John E. Sununu, in a wickedly clever column for The Boston Globe, compared the bungled rollout of the Affordable Care Act and the act itself to several classic moments in modern television comedy. In one, Seinfeld character George Costanza smells smoke at a birthday party and knocks children and grandmothers out of the way as he flees in terror. In the other, a Saturday Night Live skit, Dan Aykroyd, portraying chef Julia Child, blithely goes about cooking after having severed an artery.
In their haste to distance themselves from Obamacare, Sununu said, many Democrats are acting like Costanza. The president, like Aykroyd. He’s right on both counts. And he says that neither he nor anyone else knows how the massive experiment President Obama launched will end. We certainly don’t, but we have a pretty good idea of where it won’t go, which is back to the way it was before the reforms to what passed for a national health care system were enacted.
Much depends on what happens over the next few weeks, when, presuming the federal exchange website is repaired enough to allow people to shop for coverage, more will be known about how many people sign up and for what. To work, the system requires the young as well as those in late middle age to buy coverage. Insurers, who want the business, are poised to launch a massive marketing campaign to attract customers, whether through a state or federal exchange or via their own websites. That should increase enrollment dramatically.
Coverage for those who enroll will begin after the first of the year, as will several more provisions of the Affordable Care Act. The most important of those, in terms of a departure from past practices, is the ban on an insurer’s ability to deny coverage to someone with a pre-existing condition or to charge them drastically more because of their affliction.
The mandate to buy coverage or pay a small tax penalty also kicks in on Jan. 1. Save for those exempt from the requirement, people who have not purchased coverage before filing their 2013 tax return will pay a penalty of $95 per adult and $47.50 per child. Presumably, the existence of the penalty will persuade millions more to buy insurance.
Attempts to delay, defund and repeal the act by Republicans, and perhaps by Democrats afraid of defeat in next fall, will continue. But the odds of success are small, given that Democrats control the Senate and the president would veto any repeal of a step toward universal health care that almost every president since Teddy Roosevelt tried to achieve.
The 29 states that have already added hundreds of thousands of poor to the rolls of the insured by expanding Medicaid aren’t going to kick them off. People with pre-existing conditions, who at long last have affordable insurance, aren’t going to give it up without a fight. In Connecticut, whose state health care exchange website works fine, more than half of those who signed up have purchased private insurance. Insurers will fight to keep the customers they’ve gained.
There will be no going back to just a few short years ago when insurers routinely kicked adult children off their parents’ plans at age 21 or when they stopped being an undergraduate. No going back to the days when insurers canceled coverage when a policy holder became seriously ill, or when hospital bills exceeded a set level. And, with luck, the movement away from fee-for-service medicine in favor of a reward for keeping patients healthy will continue, because if it doesn’t, the system will eventually collapse.
No, we don’t know where the implementation of the Affordable Care Act will lead, but it won’t be to reruns of the old health care system, which weren’t comedies.