Over 8 million people have signed up for coverage under the Affordable Care Act (ACA), exceeding the White House’s enrollment goal for the end of March. However, this number isn’t indicative of the real impact of the healthcare program; many of these people already had insurance, and this figure doesn’t include those who are newly eligible for Medicaid. But in an environment where the media’s narrative reigns supreme, hitting the goal is certainly good news for President Barack Obama’s administration.
I have had some firsthand experience with Obamacare — and it’s been mixed. After starting graduate school in 2012, I was able to go back on my parents’ insurance for a year thanks to the ACA. When that opportunity expired, the Obamacare insurance exchanges were still a year away, so I had to buy my own individual insurance. My only option was Blue Cross Blue Shield of Rhode Island (BCBSRI). BCBSRI offered subsidies to low-income customers, which I qualified for as a graduate student with limited income, so I signed myself up for one of their plans.
When Rhode Island’s exchange, HealthSource RI, went online, I was naturally curious. Insurance eligibility and subsidies are based on estimated yearly income, which is difficult for a student to measure. My current income is almost nothing, although I (hopefully) will be making more after graduation. I entered my income level as a student and was told that the exchange would have to verify my information.
In the meantime, I was informed that BCBSRI would discontinue the plan that I had, but it would continue to subsidize those ineligible for subsidies under Obamacare. Based on my most recent tax return, I qualified for BCBSRI’s subsidy, so I decided to stick with the company, though I had to choose a different plan. I ended up paying $20 more per month for insurance, and for a plan I didn’t like as much — my old plan covered one dental cleaning a year, while my new one did not.
The story does not end there. I was told in February of this year that I had been automatically enrolled in the Neighborhood Health Plan of Rhode Island. The exchange had finally verified my current income without ever informing me by email or phone. I was eligible for free insurance under Obamacare’s Medicaid expansion. Despite being relatively happy with BCBSRI and concerned about the quality of insurance under Medicaid, I decided to cancel my BCBSRI insurance and enroll in Medicaid.
Here are some takeaways from my experience.
Obamacare can be confusing. Because my insurance is only a stopgap, and because I have access to some health services through Brown University, I didn’t spend a lot of time researching my options. Still, I think of myself as a fairly savvy consumer, and this process was confusing for me at times. For instance, it took me a while to figure out that the Neighborhood Health Plan was actually Medicaid. I’ve had other friends tell me that they didn’t realize that the visible rates on the exchange included tax credits, and they would have to pay more upfront before receiving a bigger refund at tax time.
I also wasn’t able to keep the plan I liked. This is a fair criticism by Republicans — I was going to pay more for a plan that I wasn’t as happy with before qualifying for Medicaid. Despite this, my view is colored by my overall inclination to support Obamacare and my ability to afford health insurance. However, I’d like to think that I’m not alone in putting aside my annoyance in light of the laudable aims of Obamacare.
Plan-switching aside, the system is also hard to means-test. I’m not sure that I’m the kind of person Obama envisioned when he signed the Medicaid expansion, and I bet the fact that I get Medicaid must drive some Republicans crazy. But means-testing, used to determine eligibility for care, is difficult to do, especially when based solely on income. Expanding an entitlement usually means that more people who probably don’t deserve that entitlement will get it — but so will a greater number of people who actually need it.
Obamacare also has more options for individual insurance. Okay, technically BCBSRI is the only insurer besides the Medicaid insurers (Neighborhood Health Plan and UnitedHealthcare). But with the online healthcare exchange, it’s easier to see which plans you’re eligible for and to compare prices of these plans. The Rhode Island exchange itself is pretty good. While I’m still miffed that there wasn’t better communication about my eligibility, HealthSource RI was very reliable and easy to navigate. Compared to the debacle of the national website, it seemed largely glitch-free.
What is my verdict on Obamacare? It does some good things, and it will continue to get better at doing them. Some reforms, such as not allowing insurance companies to discriminate based on preexisting conditions, are here to stay — and that’s a good thing. But more fundamental reform is needed. If there’s one thing that the Supreme Court case Sebelius v. Hobby Lobby Stores, Inc. — in which an employer refused to provide contraception coverage in employee health plans — demonstrates, it’s that letting employers dictate the terms of health insurance coverage is ludicrous. The tie between employment and health insurance needs to be broken.
Honestly, I’m not sure exactly what other reforms the healthcare system needs, but I am certain that there are many that I, as someone who is neither a medical sector professional nor a professional policy maker, am unaware of. A friend in medical school once told me that healthcare should either be publicly provided or be a truly competitive market. Most other countries give the public sector a more active role in healthcare. However, a more competitive market could potentially force consumers to confront the true cost of medical care and make more informed choices, driving down aggregate healthcare spending. I can personally attest that Obamacare nudged us from an unacceptable status quo towards a more reasonable system, but nevertheless, there is still a long way to go.