EDITORIAL: Thursday’s Affordable Care Act gets mixed grades, but cost remains No. 1 issue

Feb. 23--Sometimes in this era of toxic partisanship it's difficult to get a true picture of important issues.

In the matter of the Affordable Care Act, about one-third of Americans don't even realize it's the same thing as that controversial word, Obamacare.

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So The New York Times recently did a service by looking at the successes and failures of Obamacare.

Here are our grades:

Access: Incomplete.

On access, it is a partial success. About 20 million more Americans have health insurance, but not everyone.

Financial security: Success.

More Americans are protected from bankruptcy caused by medical bills. The law allows children up to age 26 to remain on the parents' health insurance, it prohibits lifetime limits and it prohibits denial for preexisting conditions. These conditions are widely accepted by Republicans and Democrats alike.

The Times also notes that Obamacare has reduced inequality, made health insurance more comprehensive and lowered the federal deficit.

Affordability: Failure.

All of the good parts of Obamacare are at risk because it is not affordable for many people, especially the middle-class people who don't qualify for subsidies.

The fatal flaw of the Affordable Care Act has always been its failure to sufficiently deal with cost. The political ploy seemed to be to provide more Americans with health insurance up front and deal with cost later.

The results now can be seen as major insurers pull back from the federal exchange market.

States such as Alaska and Oklahoma have just one insurer in the exchanges. This is especially true in rural areas.

Many insurers are losing money on the federal exchanges.

Insurers have been reducing doctor networks and raising deductibles to the point that the insurance doesn't make sense. As a result, 6.5 million Americans chose to pay penalties last year. The average penalty was about $470, The New York Times reported.

A Kaiser Health Tracking Poll asked adults for their health priorities.

Repealing Obamacare falls behind these priorities involving cost:

--Lowering the amount people pay for health insurance.

--Lowering the cost of prescription drugs.

--Dealing with the prescription painkiller epidemic.

Simplicity: Failure.

Many working people see all the choices involved in Obamacare as confusing; some would just as soon try Medicaid, which is far simpler.

"Selecting the right health plan is often frustrating and impossible for Americans unsure of their health needs," the Times reported.

The original promise, if you like your plan, you can keep it, was broken.

Improved health: Too early to tell.

Health involves a combination of personal lifestyles along with medical services. Healthy people use good diet, have exercise and get regular checkups.

A small percentage of Americans use a large share of the nation's medical care. These are people with multiple chronic conditions, such as obesity, diabetes and heart conditions, who need outstanding primary care to stay out of hospitals and emergency rooms.

In fact, the 10 percent of patients with the highest medical costs accounted for 66 percent of health spending, according to the Kaiser Family Foundation.

Chronic diseases are among the most expensive based on 2013 figures:

--Diabetes: $101 billion.

--Heart disease: $88 billion.

--Back and neck pain: $88 billion.

Spending on diabetes is increasing at 6 percent per year.

MEDICAID EXPANSION

Many of the chronically ill Americans turn to Medicaid.

Expansion of Medicaid was a key part of Obamacare, but a number of states like Florida resisted it for largely ideological reasons.

It seems likely that the Trump administration would go along with one of the Republican plans that involve fewer federal strings with expansion of Medicaid.

Two Republican-dominated states, Indiana and Ohio, have shown good results with Medicaid plans that have used the private market and emphasized personal responsibility.

SAFETY NET HOSPITALS

Obamacare presumed that by expanding Medicaid the hospitals serving the poor like UF Health Jacksonville would not need special subsidies because they would have more paying customers.

When Florida leaders refused to expand Medicaid, safety net hospitals were left vulnerable. The federal government agreed to renewing subsidies, but this has become an annual trauma for them.

If Obamacare is repealed, safety net hospitals will need subsidies restored.

REPLACING RESPONSIBLY

Americans generally have good common sense as shown by a recent Rasmussen poll regarding the repeal and replacement of Obamacare.

A majority, 56 percent, said the president and Congress should go through the law, piece by piece, and improve it.

In short, keep the good parts and either improve or replace the failing ones.

Only 30 percent say the entire law should be repealed and start over.

KEY TO SUCCESS

To keep insurers involved in the federal exchange, there is one simple solution, writes health insurance industry analyst Robert Laszewski.

Insurance carriers must be subsidized for the losses they incur from taking on sick patients.

This has been called a bailout by critics, but somebody has to find a way to pay for these expensive patients.

Without this, a replacement plan will be a "fiasco," Laszewski told Vox.

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