The Echo Chamber: Inside Affordable Care

There’s a spot on campus, right behind Eaton Hall, where, if said just at the right angle, an echo of your voice can be heard. At Tufts, an echo of political thought and ideas can be heard not just behind Eaton Hall, but all around us. Tufts, like many liberal arts universities around the country, is enclosed in its own bubble, its own echo chamber.

This column is not meant to be the needle that pops that ideological bubble, but rather a bottle of Windex to provide a clearer window into a different perspective. I will be diving deep into complicated political topics, describing them as they are, not as they are perceived, while attempting to be as neutral as possible. All I ask is that you enjoy some time outside The Echo Chamber.

Ideas? Send them to daniel.lewis@tufts.edu.

One of Obama’s defining pieces of legislation, the Affordable Care Act (ACA), is five years in the running and the jury is still out on its success. Many of us see the ACA as a great step forward toward universal healthcare in the United States. It has brought the number of uninsured Americans to the lowest level in history, with 85 percent of those newly insured considered low-income earners.

But those outside of our echo chamber see things a bit differently. Currently, the majority of Americans have a negative outlook on the ACA, even though most agree with its premise: healthcare for all. It’s easy to blame this disparity in opinion on unnecessary politicization, but there is a reason why three of the top five health insurance providers in the United States have begun to scale back their participation in the ACA, and it is by no means just political.

But what are the problems with the ACA?

The ACA has three core tenets: first, the expansion of Medicaid (government subsidized healthcare for lower-income Americans); second, federally-regulated insurance marketplaces; and third, an anti-discrimination policy for those with a history of illness.

The expanded Medicaid coverage is a staple of the ACA’s effectiveness, with 31 states continuing the expansion of their Medicaid coverage to adults who earn up to 138 percent of the poverty line. But this aspect has been made optional due to a 2015 Supreme Court ruling.

The second facet, the marketplaces, was designed to establish central trading locations for insurers in a given area—like a farmers’ market for health insurers. In 2013, Obama rather optimistically predicted that because of these new exchanges, we would see an increase in competition lowering prices in the process. This has yet to pan out, with most research pointing to a drastic increase in prices and many districts left with only a handful of providers monopolizing exchanges.

The third and final facet — restricting insurers’ ability to discriminate based on health history — is great in principle. In practice, it’s much more difficult. Health insurers need healthy people to cover the costs of the old and sickly who require more care. Because of this, it is not in an insurer’s interest to have someone who needs health insurance sign up. The ACA attempted to fix this paradox by restricting insurers’ ability to discriminate based on health history. In college terms, the ACA forced “need-blind admissions” for health problems onto participating health insurers.

In ACA terms, this is called “risk adjustment,” where insurers within the federally-run exchanges who have more healthy clients partially subsidize those who take on the burden of the old and sick. But with 15 percent fewer young people signing on than the government had hoped, it has been very difficult for the healthy to fully offset the cost of the sickly, and risk adjustment has ended up creating serious headaches for providers and consumers alike.

The effectiveness of the ACA can be interpreted as you see it: a sign of hope for the future, or a floundering overreach of the federal government. I just hope that now you can bring a little more discussion to The Echo Chamber.

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