Congresswoman Shelley Moore Capito's recent column in the Sunday Gazette-Mail on the health reform law, also known as Obamacare, generated heat but shed little light on the complex subject of health-care reform.
Let's examine some facts about the American health-care system and the efforts of Obamacare to start much-needed change.
First, the American health-care system is broken. Before Obamacare, more and more Americans were losing health insurance coverage. Employer-based coverage has declined by 12 million in the past decade. Employers have been dropping coverage or shifting more of the burden to their employees long before health reform was passed. Since the passage of health reform, 3.1 million young adults have gained coverage through their parents' policies, and millions more will do so when the major provisions of reform are implemented in January 2014.
Rep. Capito claims that the average premium in the individual market will increase by 56 percent. True, premiums in the individual market will increase. Why? Because the new law prohibits insurance companies from imposing pre-existing condition limitations. Currently, insurance companies cherry pick their customers, insuring only young healthy individuals, and pricing older people out of the market. That policy ends in eight months when insurance companies can no longer discriminate against individuals based on pre-existing conditions. Does Rep. Capito want to continue allowing the insurance industry to discriminate against people with pre-existing conditions? If so, she should be forthright with her constituents.
Another reason for increases in the premiums in the individual market is that starting next January people will have better coverage. For example, currently most individual policies in West Virginia do not cover maternity benefits. All individual policies will be required to cover maternity benefits starting on Jan. 1, 2014, unless Rep. Capito has her way and repeals Obamacare.
She also failed to mention that individuals and families will receive substantial assistance with the cost of their premiums in the individual market. An individual or family who earns too much to qualify for Medicaid will receive premium assistance on a sliding scale up to 400 percent of the federal poverty level, about $78,000 for a family of three. And there is additional assistance with the cost of deductibles and co-payments.
Young healthy people under age 30 who are betting that they won't need medical care can buy a catastrophic policy at an affordable price. This will be a good deal for them because if they do get sick, they will still be able to buy a better policy when the next open enrollment rolls around.