Connecticut shows that Obamacare can work
If only all the states could have acted like Connecticut, and had Congress worked in bipartisan fashion to improve the law, the Affordable Care Act might have actually been a success rather than a political collision point. The latest open enrollment period began Saturday. By the time it is completed, the state expects only about 107,000 individuals will still be without health insurance coverage, or 3 percent of Connecticut's 3.6 million people, said the man now leading Connecticut's public health insurance exchange.
Factor in statistical modeling that shows 2 percent of the population, about 70,000 of those 107,000 people, will never obtain health insurance no matter the incentives or opportunities, and the program's success is more impressive, said James Wadleigh.
Wasleigh, 47, is the interim CEO of Access Health CT, which has been a national leader in implementing the provisions of the health care law. He replaced the former chief, Kevin Counihan, who left to take the job directing HealthCare.gov, the federal government exchange offered to states that did not set up state exchanges, most led by Republican governors.
Unlike the federal exchange, which got off to a horrenedous start, the Connecticut exchange has worked fairly well from the beginning.
During the first round of sign ups, Connecticut added 280,000 individuals to the ranks of the insured, nearly tripling its goal. Of that number, 75,000 are paying premiums to private insurers and 205,000 signed up for Medicaid, expanded by the ACA. About half the states - again led by Republicans - chose not to offer expanded Medicaid to help struggling working families access health insurance.
In bright red Texas, for example, 26.3 percent of the population has no health coverage, 5.8 million people, yet under Gov. Rick Perry and the Republican legislature, Texas has done all it can to undermine the Affordable Care Act. The Republican governor-elect, Greg Abbott, promises to stay the course.
Nationally, Republicans have run against Obamacare since its passage and that tactic certainly seems to be working. It appears a product of the fact the poor, who most benefit from the ACA, do not vote in large numbers. In the South, many poor who do vote stick with the Republicans, seemingly against their own self-interest.
The successful political campaign against the health law is also a result of Obama doing a lousy job of defending his own signature legislation and of gutless Democratic lawmakers refusing to even try, cowed by the relentless Republican attacks.
Connecticut, however, has proved the law is workable, though challenging.
Those who visit www.accesshealthct.com get to choose from four tiers of plans - bronze, silver, gold and platinum - and using various permutations within those tiers have access to 180 plans, said Wasleigh.
It is a complex undertaking to try to merge a combination of the private and public sector to provide the opportunity for universal insurance coverage. The easier alternative would be a single-payer, Medicare-for-all system. But, ironically, the president and Democrats sought instead to implement a conservative-based model that utilizes private insurance companies competing on exchanges to provide coverage, with penalties for those who do not sign up.
Wasleigh estimates about 70 percent of those who originally signed up in Connecticut can have their plans automatically renewed. However, if some circumstances change - for example, a shift of 10 percent or more in income, a changed family situation, a change in age that pushes someone on to Medicare or a child off the family insurance at 26 - customers have to return to the exchange and reapply with the new information.
Also, 30,000 customers - 21,000 who qualified for Medicaid, 9,000 with private insurance - need to verify income or their residency status if they want to retain coverage.
The ACA could benefit from changes, among them eliminating the 2.3-percent excise tax on sales of most medical devices. Congress should also adjust or end the requirement that by 2016 all businesses with more than 50 full-time equivalent (FTE) employees provide health insurance for their full-time employees, or pay a per month "Employer Shared Responsibility Payment" on their federal tax return. The problem with the provision is it provides a disincentive to hire workers for full-time positions.
If Republicans had shown a willingness to rework the law with Democrats, as has been the case with other major social programs, instead of focusing on repeal for political advantage, the nation could well have a health care law that was working across the nation as well as it is in Connecticut. With Republicans in charge of the House and Senate, it is difficult to predict where things go from here.
Paul Choiniere is editorial page editor.
Comment threads are monitored for 48 hours after publication and then closed.