Obamacare: A change for the better, or the worse?

It is the most contentious, and least understood, law of our age, said Bob Burnett in HuffingtonPost.com. As the Affordable Care Act’s health insurance exchanges opened for business this week, an ABC News/Washington Post poll found that 62 percent of the public admitted they didn’t understand what the law would actually do. Despite all the hoopla, “most people will never notice it,” said Ezra Klein in WashingtonPost.com. The 80 percent of Americans who get health insurance though employers or Medicare and Medicaid will not be affected by the Affordable Care Act, except to enjoy more protection from their insurance companies. For the 20 percent of Americans who are uninsured or already buy their own insurance, the ACA is very good news. They will now be able to buy private insurance through competitive exchanges set up in every state. Thanks to subsidies for low- and middle-income citizens, and competition between providers, the Department of Health and Human Services estimated that 56 percent of people who are uninsured will pay less than $100 per month for policies. People with pre-existing conditions will buy policies with the same rates as healthy people. It’s estimated that half of the 50 million Americans currently without insurance will have coverage by the end of the decade.

That all sounds wonderful, said James Taranto in WSJ.com, but there’s a fundamental flaw at the heart of Obamacare. The White House says it needs at least 2.7 million healthy 18- to 34-year-olds in the exchanges to offset the cost of providing care for millions of older and sicker uninsured people. The administration is trying to bully young people into signing up by penalizing the uninsured—in 2014 they’ll have to pay a fine of $95, or 1 percent of income, whichever is higher. But many young people are barely making ends meet, and may well decide it’s cheaper to pay that small fine than a monthly premium of $100 or more. Without those healthy youngsters in the insurance pool, premium costs will soon soar.

Well-meaning government intervention always has unintended consequences, said Deroy Murdock in NationalReview.com, and Obamacare is no exception. Since the law requires companies with more than 50 employees to provide health insurance to those who work 30 hours or more a week, at least 313 businesses have decided to slash the hours of 30,377 workers to under 30 hours. These employees will suffer pay cuts of more than 25 percent. This is the “cruelty that Obamacare is unleashing on American workers.” The quality of care offered under this unwieldy law will also be substandard, said The Wall Street Journal in an editorial. Insurance companies already admit that the only way they can provide customers with affordable policies is to severely limit the network of physicians and hospitals they can access. “Forget about seeing that specialist, and queue up at the community hospital.”

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The Affordable Care Act might have limits and flaws, said Josh Barro in BusinessInsider.com, but what’s the alternative? Republicans have discussed a vague plan that would offer large tax deductions to individuals who buy their own insurance. They also say they’d create high-risk pools to cover sick people excluded from the traditional insurance market. But any plan that extends coverage to millions of people “would cost a lot of taxpayer money to implement”—probably $15 billion a year or more. That makes it a nonstarter for conservatives. Republicans would rather cover their eyes and pretend everything’s fine with our dysfunctional health system, which forces taxpayers to spend $49 billion a year subsidizing emergency room care for uninsured Americans.

Returning to the status quo is not an option, said Jonathan Cohn on NewRepublic.com. The percentage of Americans with employer-based insurance has dropped from 70 percent in 2000 to just 58 percent today. One out of six Americans has no coverage at all. People with chronic illnesses can’t change jobs for fear of losing coverage, and every year, about 2 million are hit with devastating medical bills that push them into bankruptcy. The ACA’s fixes for these problems are complicated, and “full of compromises” made to get it passed. But the important question is not whether the ACA will be perfect or without glitches. The question is whether the reforms improve on a broken, incredibly costly system, or whether “restoring the old system—the one that caused so much misery—is a better alternative.”