Crunch Time For Obamacare

Obamacare Upheld

Obamacare Upheld

According to the Dec. 11, 2013 issue of the New York Times, “nearly 365,000 people picked a health insurance plan through state and federal exchanges established by the Affordable Care Act (ACA) through the end of November. While the pace of enrollment picked up last month, it is still a fraction of the 1.2 million target that the Obama administration had set for the first two months.” In Iowa, the target was 6,970 individuals enrolled with only 11 percent attainment (757 individuals). What’s going on?

In 2012, the American Community Survey, found the number of uninsured people in Iowa was 254,275 uninsured, or 8.4 percent of our population. I’m not a statistician, but enrolling about 7,000 by Nov. 30 seems a reasonable target. Out of the whole, there are some, where household income exceeds $50,000 (91,073 uninsured), and non-citizens (28,901 uninsured), who would not be eligible. Nonetheless, enrolling only 757 individuals is an embarrassingly low number.

The enrollment period for coverage Jan. 1, 2014 was extended after the website trouble to Dec. 23, so some may have delayed to use this time. I submit, at its core, the problem is a cultural issue, rather than policy. Here are my thoughts:

People I know don’t understand health insurance is mandatory in 2014, and if they do, the perception is there is no reason to get it given the slight penalties.

Wellmark, the largest health insurance company in Iowa is not in the exchange, indicating that if one has insurance where the policy is grandfathered, it may be better to wait to change policies until Wellmark enters the exchange for the 2015 calendar year

The exchange requires some married couples to move from a joint policy to individual policies. That doesn’t seem right, and it was not explained well, if at all. Why change unless one understands this aspect of the ACA?

The folks at the exchange I spoke with were not prepared to deal with the idea that some people do not know how much income they will have in 2014, thus creating uncertainty about the amount of the tax credit, and how much will be paid out of pocket. Uncertainty for this and other reasons will be an obstacle to enrollment.

There have been success stories about people who have benefited from the Affordable Care Act, using expanded Medicaid and the insurance exchanges. On the ground level, the failure to attain targeted enrollments seems to be a failure on the part of government to recognize that enrolling in the exchange is not intuitive, and that people who may qualify for insurance may also need persuasion. This is particularly true given the all-out assault on the Affordable Care Act by some Iowans, including Rep. Steve King (R-Kiron).

Too, where is Organizing for Action? While enrolling people in the Affordable Care Act may not be their primary mission (Organizing for Action is the grassroots movement to pass legislation relating to the Obama administration’s agenda), failure to gain a better degree of compliance with the ACA will result in a policy failure for the administration, and hinder OFA’s progress going forward. OFA has a self interest in the success or failure of the ACA. Having missed identifying the need for persuasion, it seems doubtful anyone in the administration picked up the phone to call OFA.

With the deadline for Jan. 1 2014 coverage less than two weeks away, what’s a person to do? For me, that means keeping the policy I have for another year, even if we qualify for a less expensive policy on the exchange. For the tens of thousands of Iowans who don’t have health insurance it remains to be seen. While the benefits of the ACA are pretty clear, even those who would be helped the most by the law are just not buying it.

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6 Responses to Crunch Time For Obamacare

  1. DianeR says:

    I’ve had health insurance through Wellmark and the benefits have been relatively decent even though the only way I could afford it was with it’s highest deductible policy. I’ve also been a huge supporter of the ACA because everyone should have coverage.

    But this week, I was flabbergasted when I found out what my rates are going to become when I have to make the switch in 2015. My $250/month 80/20 copayment policy is jumping to $600-700/month. If I choose a lower premium (375-500+) that will mean I have to shell out anywhere from a $4000-12,000 deductible before Wellmark starts paying. The copayment will be anywhere from 60/40 to 70/30, depending on the policy I select.

    This is horrible. I will be paying for health insurance that is 50-100% more expensive than my current plan and I won’t even have the funds to get medical care. This is the ACA?

    Has anyone else had experiences like this? I make a little too much to qualify for subsidies, but I’m sure as hell not rolling in the dough, and I’m putting one of my kids through college.

    I’m all for everyone having coverage, and in all honesty, a single payor system is what I have supported all along. Are these rates in place so Wellmark and others can keep their profits high at the expense of their customers?


    • Paul Deaton says:


      Thanks for reading my post on Blog for Iowa.

      The thing no one is talking about, that will impact 2015 rates, is that the ACA built in every known method of cutting health care costs. Already health insurance companies are seeing reduced health care delivery costs that will reduce rates. How much we can’t know, but the fact Wellmark took such a low rate increase on individual policies for next year is an indicator that the law is working as it was designed. That is positive news for future rates. Check out Paul Krugman’s article on this in the New York Times here:

      As you may know, any rate increase has to be approved by the Iowa Insurance Commissioner. I’m not sure where you got your 2015 rates, but in the past, Wellmark has submitted proposed rates to the commissioner in November of the year preceding the one in which they would go into effect, with final approval in early January. With the switch to open enrollment for January 1, that may have been moved to earlier in the year, but in any case, I don’t think we’ll know 2015 rates until fourth quarter 2014 as we go into open enrollment again.

      Thanks again for reading Blog for Iowa. Good luck with the transition.

      Regards, Paul


  2. Trish Nelson says:

    As Paul stated in the article, Wellmark unfortunately isn’t participating in the ACA at this time. In addition, Wellmark has been running ads discouraging people from signing up for the ACA. This isn’t helping matters.

    Thanks for reading Blog for Iowa.


  3. DianeR says:

    My insurance broker gave me current rates with the new Wellmark plans and then projected a small increase for 2015. These rates I mentioned were for 2014 if I were to select one of the new plans for this coming year. Obviously, I’m not.

    I’m not sure I’m seeing any significant reductions in medical care. My last bill from the University of Iowa – $650 in blood work charged by the hospital – of which, my health plan pays $167 and I pay $42. With the ACA, I’ll pay $209 instead of the $42 until meet my deductible of many thousands of dollars, just depending on which plan I choose, for several hundred dollars more per month.

    Sorry, I just don’t see how this is benefiting me, and how I’m going to be able to afford medical care. I’m very discouraged.


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