Thursday, March 26, 2015
Let's start on an upbeat. Next to what we had before, Obamacare has been a spectacular success. The Affordable Care Act has brought medical security to millions of previously uninsured Americans and has helped slow the rise in health care spending.
But the health reforms would have been more spectacular had they been simpler to follow and understand. Complexity is their big flaw. It was the product of politicians' cutting so many private interests into the deal -- and the fear of radically changing a system of health coverage largely based on employment.
Thus, many Americans who received tax credits to buy coverage on the health insurance exchanges now must calculate whether they overestimated or underestimated their 2014 income in determining their subsidy.
If they made more than they expected, they must repay some of the money. This is probably a small price to pay for subsidized coverage, especially if one has an expensive medical condition, but it is an added headache at tax time.
Others are finding that they earned less than they thought they would in the year. They can expect a refund. A nicer surprise, for sure, but still, figuring these things out is a chore.
There's another group that ignored the requirement to obtain coverage. This year, those folks are facing a tax penalty of $95 or 1 percent of their income, whichever number is higher. That penalty will rise with the years. Many can obtain an exemption from this fine but must apply for it.
Some refused on political grounds; they objected to being forced to buy coverage. Others were unaware of the mandate. And many people just couldn't wrap their brains around the concept of exchanges and the choices they offered.
Bringing the entire population into the insurance risk pool is essential to any health reform, and a mandate to buy coverage is one way to get there. But that puts a burden on a lot of ordinary folk, each trying to work out his or her situation.
Medicare brings everyone 65 or older into the program by simply enrolling them. Hospital coverage is automatic. Those wanting coverage for visits to the doctor can pay extra. If they want coverage for drugs, they can buy a drug plan. Or they can sign up with a Medicare Advantage plan that does all or most of the above.
Medicare does offer subsidies to some low-income people, but they are relatively simple. The program is funded by payroll taxes, premiums and the Treasury. No one needs an accountant to figure what one gets or pays.
There's much waste in Medicare. It must be addressed. But the program does curb spending through its low administration costs and by setting a price on each service.
It's no small irony that some of Obamacare's leading critics want to make Medicare more like Obamacare. A leading Republican budgeteer, Rep. Paul Ryan, proposes a system whereby the elderly would receive vouchers to buy coverage from a private insurer on ... a health insurance exchange.
Gone would be the guaranteed benefits. Patients of modest means wanting choice of doctor might have to settle for plans with limited provider networks. Those who object would have to fight it out with the insurer. The Ryan plan would give insurers more freedom to determine the benefits offered by their plans. Companies could then tailor their offerings to attract the healthy -- and therefore cheaper -- enrollees and avoid the sickly.
Would some leader in Washington start the wheels turning to bring all Americans into the promised land of Medicare as we now know it? And don't repeal Obamacare. Mend it and bend it to fit into Medicare.
Follow Froma Harrop on Twitter @FromaHarrop. She can be reached at firstname.lastname@example.org. To find out more about Froma Harrop and read features by other Creators writers and cartoonists, visit the Creators Web page at www.creators.com.
COPYRIGHT 2015 CREATORS.COM
See Other Political Commentary.
See Other Commentaries by Froma Harrop.
Views expressed in this column are those of the author, not those of Rasmussen Reports. Comments about this content should be directed to the author or syndicate.
Rasmussen Reports is a media company specializing in the collection, publication and distribution of public opinion information.
We conduct public opinion polls on a variety of topics to inform our audience on events in the news and other topics of interest. To ensure editorial control and independence, we pay for the polls ourselves and generate revenue through the sale of subscriptions, sponsorships, and advertising. Nightly polling on politics, business and lifestyle topics provides the content to update the Rasmussen Reports web site many times each day. If it's in the news, it's in our polls. Additionally, the data drives a daily update newsletter and various media outlets across the country.
Some information, including the Rasmussen Reports daily Presidential Tracking Poll and commentaries are available for free to the general public. Subscriptions are available for $4.95 a month or 34.95 a year that provide subscribers with exclusive access to more than 20 stories per week on upcoming elections, consumer confidence, and issues that affect us all. For those who are really into the numbers, Platinum Members can review demographic crosstabs and a full history of our data.
To learn more about our methodology, click here.