Politics & Policy

Obamacare: Treat the Subsidy Epidemic with Portability and Government Clinics

(Valeriya Potapova/Dreamstime)

Obamacare’s latest victory is a boon for health-insurance companies and for government expansion, but it doesn’t automatically translate into actual health care. Patients in the doctor’s office today are facing the same problems they were facing yesterday. 

According to the Commonwealth Fund, health-insurance premiums are now at 23 percent of median family income, up two percentage points since Obamacare was first instituted in 2010. This continuing increase reflects rising health-care costs and the cost of covering sick patients with pre-existing conditions. This expanded coverage would seem to be an admirable goal, but there are big problems in the Affordable Care Act’s design.

One of the biggest flaws unmasked during the just-concluded battle before SCOTUS, which Obamacare won, is the enormous dependence on subsidies to keep the Obamacare boat afloat. According to the Obama administration, of the 11.7 million Americans who now receive health insurance from one of the state or federally run exchanges, 86 percent receive subsidies. This means that health-insurance expansion is at its core another government entitlement, and a burden to the taxpayer. 

Don’t get me wrong. The goal of providing health care for all is a lofty and important one. But health insurance isn’t an automatic way to get there. Most of my patients who have Obamacare are carrying a deductible of $5,000 or more, which means that even with the subsidies, they end up paying for most of their basic care out of their own pockets. Plus, the health care they receive is watered down. Patients with Obamacare are faced with a narrow network of highly regulated choices, because most doctors are not included in the networks either by choice or because a plan doesn’t include them. This means that even if I am a primary-care provider of a policy offered on the exchange, I might not be able to find an orthopedist I know to refer my patient to if she breaks her leg or a surgeon if she has breast cancer. 

At its core the Obamacare law caters to insurance companies that love having a broader base of patients, especially if it is subsidized by the government.

What is the solution? Clearly the Affordable Care Act is here to stay, so efforts must be made to reform it. At its core the law caters to insurance companies that love having a broader base of patients, especially if it is subsidized by the government. But critics of Obamacare, myself included, have maintained from the beginning that portability of health insurance across state lines is essential to foster competition and drive down inflated premiums. This could also decrease the need for federal subsidies. As it is now, premium increases are uneven, in some cases rising as much as 30 percent a year. But if you could go across state lines to get a comparable policy, insurance companies would be kept more honest in terms of the premiums they set. 

I have also always felt that if the federal government wants to expand its role in the health-care world, it should do so by expanding the National Health Services Corp. This solution might not be popular politically on either side of the aisle, but government-run clinics staffed by government-salaried physicians would provide actual care to those in need rather than an insurance promise. Those who are uninsured and don’t have access to doctors or treatments would be provided with a safety net. At the same time, a catastrophic insurance for all could be offered that would be more usable and cost-effective than an insurance plan that guarantees you health care but is then too often unable to provide it.

Marc Siegel is a professor of medicine and the medical director of Doctor Radio at NYU Langone Medical Center. He is also a Fox News medical correspondent.

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