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So, How's this National Health Care Thing Working?

More Mississippians may not have health insurance in the aftermath of the Affordable Care Act than it had before the federal law — designed to increase coverage — was passed in 2010.
No one knows for sure.
But uncertainty has been a problem all along. There were no dead-on numbers while the law was being debated, and while there are better numbers today, those who like the idea of national health insurance skew the figures one way and those opposed skew them the other.
WalletHub.com is the source saying Mississippians without health insurance will increase. It is non-partisan and draws its core figures from the reliable Kaiser Family Foundation, so that adds some credibility to its claim that 18 percent of Mississippians had no insurance pre-Obamacare and 21.5 percent will have no insurance, public or private, after. Texas, at 24.8 percent, is the only state with a higher proportion of uninsured residents than Mississippi.
Otherwise, how is the roll out going?
Less than remarkable.
While Mississippi is the only state projected to have an increase, the most credible figures say nationally the act has reduced the ranks of the uninsured by 3.7 percent — from 17.9 percent of Americans before Obamacare to 14.2 percent today.
Some states are doing exceptionally well. In Massachusetts, where Republican former Gov. Mitt Romney had shepherded a universal health law before Obamacare, 97 percent of residents have health insurance.
In other states, mostly in the South, not so well.
Let’s talk about why.
The Affordable Care Act was driven by the president and by Democrats in Congress as do-gooder legislation with a powerful subtext.
The do-gooder aspect was that health care is a human right. A vast majority of Americans, including Mississippians, agree that people who need health care should not be turned away at the hospital or clinic door; that no one should suffer or die due to inability to pay for medicine.
The subtext on Capitol Hill was that tax payments into the ever-widening maw of the two largest existing public health insurance programs — Medicaid and Medicare — were eating into state and federal funds like a cancer. The idea was to rebalance, shift the cost burden.
Overall, the tactical plan of Obamacare was to:

  • Encourage uninsured individuals and heads of uninsured households to purchase policies through state-administered private marketplaces, offering subsidies to prevent undue hardships and imposing tax penalties on the noncompliant.
  • Encourage employers to offer group policies, imposing fines on those who did not.
  • Assist the working poor by expanding Medicaid, the federal-state public insurance program for the poor and disabled, to people earning up to 138 percent of the federal poverty level.

Mississippi officials greeted the Affordable Care Act as they do most federal initiatives — as a violation of state sovereignty. We love federal dollars, accepting lots more than we pay in, but we want Uncle Sam to be our ATM. Give us cash, but don’t tell us how to spend it.
As to specifically why the law isn’t working as well as it could, the decision of U.S. Supreme Court detaching the requirement that states expand their Medicaid limits is key. Congress wanted non-compliant states kicked out, meaning 500,000 or more Mississippians on pre-2010 Medicaid would lose benefits. Not surprisingly, after that aspect of the act was deemed unconstitutional, Mississippi joined about 25 other states in continuing to accept federal dollars for Medicaid but without the expansion to embrace working people who earned decent money, but not enough to afford private insurance.
In Mississippi and other states, these working people are in a gap. They earn too much to get a Medicaid card and not enough for a subsidized marketplace policy because eligibility starts at 138 percent of the poverty level.
And gap is not insignificant. Kaiser numbers show 136,200 of Mississippi’s 454,000 residents under 65 who do not have health insurance would have been eligible for Medicaid with the expansion. And that, of course, would have been a step toward reducing the numbers of uninsured as opposed to increasing it.
So where we are is that someone needs to blink. For the Affordable Care Act to have any shot at success, Congress will need to work out legal alternatives for states, including Mississippi, who reject the Medicaid expansion. Of course, the states could have a change of heart and expand Medicaid, too — but that isn’t likely.
The political reality is that the president and Congress are simply not going to talk about major changes or even tweaks until after the 2016 presidential election. Until then, Obamacare is adrift. A lot of lawmaking with a very limited impact.
Charlie Mitchell is a Mississippi journalist. Write to him at cmitchell43@yahoo.com.

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