ObamaCare's Plans Are Worse
How the Affordable Care Act raises prices and limits medical choices.
Nov. 29, 2013 7:05 p.m. ET
Even as President Obama reluctantly granted Americans thrown off their health plans quasi-permission to possibly keep them, he called them "the folks who, over time, I think, are going to find that the marketplaces are better." He means the ObamaCare exchanges that are replacing the private insurance market, adding that "it's important that we don't pretend that somehow that's a place worth going back to."
Easy for him to say. The reason this furor will continue even if the website is fixed is that the public is learning that ObamaCare's insurance costs more in return for worse coverage.
Mr. Obama and his liberal allies call the old plans "substandard," but he doesn't mean from the perspective of the consumers who bought them. He means people were free to choose insurance that wasn't designed to serve his social equity and income redistribution goals. In his view, many people must pay first-class fares for coach seats so others can pay less and receive extra benefits.
Liberals justify these coercive cross-subsidies as necessary to finance coverage for the uninsured and those with pre-existing conditions. But government usually helps the less fortunate honestly by raising taxes to fund programs. In summer 2009, Senate Democrats put out such a bill, and the $1.6 trillion sticker shock led them to hide the transfers by forcing people to buy overpriced products.
This political mugging is especially unfair to the people whose plans on the current individual market are being taken away. The majority of these consumers are self-employed or small-business owners. They're middle class, rarely affluent. They took responsibility for their care without government aid, and unlike people in the job-based system, they paid with after-tax dollars.
Now they're being punished for the crime of not subsidizing ObamaCare, even though the individual market was never as dysfunctional or high cost as liberals claim. In 2012, average U.S. individual premiums were $190, ranging from a low of $123 in North Dakota to a high of $385 in Massachusetts. Average premiums for family plans fell that year by 0.5% to $412.
Those numbers come from the 13,000 different policies from 180 insurers sold on eHealthInsurance.com, the online shopping brokerage that works. (Technological wonders never cease.) Individuals can make the trade-offs between costs and benefits for themselves. This wide variety is proof that humans don't all want or need the same thing. If they did, there would be no need for a market and government could satisfy everybody.
That is precisely what the Obama health planners believe they can do. Regulators mandated a very rich level of "essential" health benefits that all plans in the individual market must cover, regardless of cost. This year eHealth reported that its data show individual premiums must be 47% higher than the old average to fund the new categories in the individual market.
Meanwhile, ObamaCare's plans are limited to essentially four. Yes, four. The law converts insurance products on the ObamaCare exchanges into interchangeable commodities that finance the same standard benefit at the same average expense over four tiers known as bronze, silver, gold and platinum.
So, for example, a bronze plan covers 60% of health-care expenses and the beneficiary pays a lower premium to pick up the remaining 40% out of pocket. Platinum carries a higher premium for a 90%-10% split. But there can be little deviation from the formulas—that is, there is little room for innovation or policy choice—to suit customer preferences.
In any case all four tiers are scrap-metal grade, because the rules ObamaCare imposes to create a supposedly superior insurance product are resulting in an objectively inferior medical product. The new mandates and rules raise costs, so insurers must compensate by offering narrow and less costly networks of doctors, hospitals and other providers in their ObamaCare products. Insurers thus restrict care and patient choice of physicians in exchange for discounted reimbursement rates, much as Medicaid does.
Nearly half of the ObamaCare plans are tightly managed HMOs, according to a McKinsey & Co. analysis. In states like California, Missouri and New Hampshire, many networks are 40% or 45% the size of those offered for normal commercial coverage. Patients face the prospect of waiting months and driving miles to clinics and county hospitals.
Narrow networks can be a useful cost-control tool, to the extent people choose to give up medical options in return for lower premiums. But that's rarely what people want when they're choosing with their own money. Some 82.5% of eHealth customers in 2012 purchased preferred provider organization plans (PPOs) that are structured so patients can visit virtually any physician.
The awful irony of this new ObamaCare health system is that all adults now enjoy mandated pediatric vision benefits, even if they don't have kids, but parents can't take their daughter to an expensive children's hospital if she gets really sick. Everybody gets "free" preventive checkups with no copays, but not treatment for a complex illness from specialists at an academic medical center.
If the old individual market was as bad as Mr. Obama said it was, then he shouldn't pretend it's a place worth going back to, even for a year's delay. His "fix" is necessary politically because ObamaCare's willful destruction of this alternative is the worst act of government mayhem since FDR's National Recovery Act. The Affordable Care Act's main achievement is turning out to be diminishing affordable care.