Although Congressional Republicans and the Trump Administration may not want to stop their relentless assault on the Affordable Care Act, aka Obamacare, there may be other reasons to persuade them to do so.
Researchers at the nonpartisan, not-for-profit RAND Corp., for example, have looked at existing studies and data and asked if the recent GOP move, in the huge tax cut bill, to halt the ACA’s health insurance mandate will have unintended consequences.
They say the repeal of the requirement that all Americans show they have health coverage when they pay their taxes may “ripple out” to other insurances they carry — meaning that tens of millions of motorists may pay more for auto insurance and businesses could see hikes in workmen’s compensation costs they already struggle to pay.
The RAND experts point out that the average American motorist forks over $850 or so already for car insurance. More than half that sum, they have written, underwrites liability coverage, claims in which an insurer “pays for medical care, lost wages and other losses inflicted when a driver is at fault in an accident. While the typical property damage bill in an auto accident is about $3,700, an average injury bill is closer to $16,000, with most of the money used to pay doctors and other health care providers.”
If both car and health insurance are widely available and accessible, the health coverage helps to hold down auto coverage costs, the RAND researchers have found, based in part on studies of what happened when the ACA permitted more young people got to stay on parental coverages.
That’s because some medical expenses that those hurt in crashes might claim on their vehicle policies just get taken care under their health coverage. “But an auto injury that puts those without health insurance in a doctor’s office,” RAND economist Paul Heaton wrote, also “might lead to treatment for pre-existing medical conditions that weren’t being addressed due to lack of funds, and ultimately this care can wind up on the auto insurer’s tab.”
Similarly, companies could see big increases in their costs for workmen’s comp if more Americans forego health coverage or take so-called skimpy plans that have such high deductibles or offer so few benefits that experts consider them the equivalent of getting no health insurance at all. As Heaton wrote:
Tweaks to the ACA may very well affect the cost of doing business for employers by changing their workers’ comp outlays, even if they don’t adjust their health insurance offerings and their health premiums remain steady. And in industries such as construction, transportation and utilities, upwards of 10 percent of payroll costs can go just to pay for workers’ comp, so any changes in workers’ comp premiums can be a big deal.
The RAND forecast also sees similar ripple impacts on liability policies affecting homeowners and their carelessness, doctors and malpractice, and retail businesses with slip-and-fall coverages.
Real numbers tell a story
Without delving into insurer “butterfly effects” — or maybe the RAND study should be filed under “What happens to Peter when you rob Paul?” — there may be a more direct, powerful incentive for partisans to reconsider their efforts to repeal, replace, or dismember the ACA: Americans, simply put, want and need affordable, accessible, and useful health insurance.
This comes through in final reports on the number of folks, coast to coast, who sought coverage under ACA exchanges: 11.8 million customers, almost the same number as in previous years. This occurred even as the GOP, after eight years of griping and passing faux ACA repeals, rolled out its biggest push ever to kill Obamacare in the Congress that partisans controlled, and with the big backing of a new Republican president.
They failed after warring against Obamacare for almost a year. They since have turned to piece-meal administrative and legislative means to, as they describe it, get the federal government out of any level or type of participation in health care, in keeping with purported fundamental GOP views. This has included slashing money to inform the public about ACA benefits and assist consumers in obtaining them. The administration also cut the time for Obamacare enrollment.
The program survives and even thrives, with 16 states increasing their ACA sign-ups, and with 6 in 10 of Obamacare enrollees describing themselves as Trump voters.
In my practice, I see the significant harms that patients suffer while seeking medical services and their heart-breaking struggles to access and afford quality medical care. GOP leaders certainly may follow democratic practices and oppose the ACA. Voters will judge the wisdom of that path, especially as it becomes evident by the day that Republicans don’t have an alternative plan to help Americans protect themselves from medical debt, bankruptcy, and getting shut out from routine and regular much less complex and continued medical care.
Congress and the president, after unacceptable political brinkmanship and now shut downs of the federal government, have passed a budget measure with some bright spots for health care and medical science. But elected officials’ conduct on critical issues like health care has consequences, and crucial mid-term elections grow nearer by the day.
