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Democrats Fight Back on ACA

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
Associated Press
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

After weeks of bruising attacks on the Affordable Care Act by House Republicans and other opponents, Democrats Thursday retaliated with a one-two punch.

First, President Barack Obama touted two positive events in the last few days related to the health law, as Kaiser Health News reports. One event is the mailing of rebate checks from insurance carriers that spent too little of the premium dollar on medical benefits; the other is the lower-than-expected prices for premiums in some state marketplaces.

AsHealth News Floridareported earlier this week, rebates of $54 million are being sent out to holders of policies that cover more than 600,000 Floridians. About half of the recipients are individuals, the rest businesses.

The second punch is a list released by House Democrats of things the ACA has already accomplished for voters by Congressional district. It lists estimates of the number of constituents who have benefited or will soon from each section of the act.

'The Affordable Care Act is lowering health insurance costs and improving benefits,” Rep. Kathy Castor, D-Tampa, said in a press release highlighting the report.  “Tampa Bay families have greater economic security due to the real-world improvements – from children with pre-existing conditions, to young adults staying on their parents insurance, and seniors paying less for drugs."

It puts opponents of the law, such as Rep. Vern Buchanan, a Republican who represents the Bradenton-Sarasota area, on the defensive by saying 187,000 Medicare beneficiaries and 177,000 younger people in his district are now getting free preventive care because of the law.

One shortcoming of the report is that it overestimates the number of uninsured constituents who will gain coverage through the law. It counts not only those who will be able to use the federal online marketplace, scheduled to launch on Oct. 1 for 2014 policies, but also those who would be covered under expanded Medicaid.

Florida, along with some other states that have Republican governors or legislative majorities, decided not to accept the federal funding that would have allowed for an expansion of Medicaid.  By the most recent estimates, about $51 billion in federal funds would have been sent to Florida over a 10-year period to cover about 1 million low-income uninsured.

In the absence of legislative action, about one-third of these low-income Floridians may still qualify for heavily subsidized coverage through the federal online marketplace. Subsidies are available to people earning up to 400 percent of the federal poverty level, or about $46,000 for an individual..

But two-thirds of those who were intended for the Medicaid expansion -- those who have incomes below 100 percent of the federal poverty level, $11,490 -- will not be covered in Florida. Consumer advocates and hospital groups have called for a special session to reconsider the "no" vote, but their hopes have faded. House Speaker Will Weatherford has said he remains staunchly against accepting federal funds to cover "able-bodied" adults.

The good news about premium costs follows months of horror stories, which accelerated after a May report by House Republicans entitled The Looming Premium Rate Shock.  Its predictions -- that premiums for small businesses could rise 50 percent and for individuals 100 percent -- were said to be derived from communication with insurers, not named.

But so far, reports from state exchanges have not borne out the warnings.  As the Department of Health and Human Servicesnoted, in the 11 state-run insurance marketplaces that have reported so far on the individual market, proposed premiums for 2014 average 18 percent below earlier estimates from the Congressional Budget Office.

The report also said that in the six states that have made information available in the market for small employers, proposed premiums average  18 percent below what similar coverage would cost without the law.  Note the word "similar." That is a key condition for the positive report.

 Both estimates are based on premium proposals for a "silver" plan in the individual and small group markets. The plans available will be bronze, silver, gold and platinum. Bronze --high-deductible catastrophic plans -- are the least expensive, and platinum will be most expensive.

Although seemingly contradictory, the reports from both sides -- dire warnings from Republicans and the hallelujah reports from Democrats -- contain elements of truth, experts say. 

The cost of the least-expensive policies for a healthy young person could go up because the law requires coverage of certain things -- such as maternity care -- that are now often not covered on individual policies. Also, young people will have to shoulder part of the burden of covering older and sicker people who now can't buy insurance at all.

On the other hand, early reports from state exchanges are showing much more moderate prices than expected. It appears that companies feel pressure to keep prices moderate now that consumers will have the ability to make apples-to-apples comparisons.  Also, officials in some states -- notably California -- have been active in negotiations with insurers, jawboning to get price relief.

Editor's note: Hear NPR correspondent Julie Rovner's analysis "White House Muddles Obamacare Messaging -- Again."

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.