How Obamacare's saboteurs are raising your health care cost

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Donald Trump has been predicting Obamacare's collapse since he began his presidential campaign more than two years ago — and certainly, no one has done more than he has to make that prophecy come true.

But Michigan's biggest health care providers and insurers still believe the health care framework the state put in place to comply with the stringent requirements established by the Affordable Care Act can be made to work for their patients and policyholders — if Congress takes steps to shore up the support beams President Trump seems determined to sabotage.

At least 900,000 more Michiganders have health coverage today than before the ACA kicked into high gear three years ago. Most joined the ranks of the insured when Michigan, in league with other states, extended Medicaid benefits to working families whose modest incomes had previously left them stranded between Medicaid eligibility and affordable health coverage.

The collapse of the Republican campaign to dial back federal funding for Medicaid means that Michigan residents who obtained coverage when the state made it easier to qualify for Medicaid benefits are safe, for now. So are the majority of workers who continue to get coverage through their employers — including small businesses that have been legally required to provide such benefits since passage of the ACA.

When Trump and other critics talk about the imminent implosion of Obamacare, they're really talking about the fragility of the state exchanges where small businesses and individuals who enjoy neither Medicaid eligibility nor employer-provided health insurance must go to purchase coverage that meets the requirements established by the ACA. 

Michigan's Health Insurance Marketplace and similar exchanges established by other states were supposed to make health care more affordable by throwing hundreds of thousands of young, relatively healthy people into the same insurance pool as their older, sicker neighbors. But even Obamacare's most enthusiastic champions concede that three years of real-world experience has revealed weaknesses in that theory.

Part of the problem is that the so-called individual mandate doesn't really require young people (or anyone else) to buy health insurance; it simply threatens to exact a tax penalty every April 15 if they fail to do so. The more people who elect to take the tax penalty rather than purchase health insurance policies, the smaller and riskier the pool of policyholders insurance companies have to provide for becomes. 

Under current federal rules, moreover, even those who decide to buy policies can drop coverage — or simply stop paying their insurance premiums — with the confidence that they'll be able to renew coverage with no penalty if they need medical services down the road. The more expensive it is to buy insurance on the state exchange, the greater the incentive to forgo coverage until an injury or serious illness arises.


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