Skip to main content

The health care fix won't work

By Aaron Carroll
updated 4:48 PM EST, Thu November 14, 2013
STORY HIGHLIGHTS
  • Aaron Carroll: Obama's quick "fix" on insurance cancellations puts off needed changes
  • He says ACA mandates adequate care; policies without it must go away
  • He says "fix" just shifts blame to the insurance companies when they cancel policies
  • Carroll: To fix broken health care, we must accept changes. There are no easy answers

Editor's note: Aaron E. Carroll is a professor of pediatrics at the Indiana University School of Medicine and the director of its Center for Health Policy and Professionalism Research. He has supported a single-payer health system during the reform debate. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.

(CNN) -- The implementation of the Affordable Care Act is not going well. First, the volume of people showing up to HealthCare.gov on October 1 completely crashed the site. Then, it turned out the data being passed up and back was completely corrupt. Then, millions of Americans began discovering that plans they "liked" were being canceled, and they were being told it was because of the Affordable Care Act.

President Obama announced an administrative fix to this problem on Thursday: an extension that allows insurers to keep people on health care plans that the Affordable Health Care act would not have allowed.

The cancellations had posed a real problem for the Obama administration, because they flew in the face of what many believe is a core promise of health care reform: that you could keep your policy if you liked it. Millions are finding out this isn't true. Those of us who have been in the weeds of health policy have known this for a long time. Most Americans did not.

Aaron Carroll
Aaron Carroll

The Affordable Care Act changes the way insurance is regulated. It declares that many services are now mandatory. This included a lot of preventive care, as well as maternity care. Any policies that don't provide these services will no longer be offered. Other policies had very low annual or lifetime limits. These, too, have to go away. Anyone who had one will need to find a new policy. It's very likely that newer policies, with more robust benefits, will be more expensive.

That will make many people unhappy.

We can argue that the new policies are still a good deal, or that much of that cost will be defrayed by subsidies, or that future protections to both beneficiaries and their families are worth the added cost, but that's somewhat beside the point. Many people feel like they were told they could keep their insurance, and now they think they have been lied to.

Obama knows the law is in trouble. Many Democrats feel like they took hard votes and stuck their necks out to support the law, and now that there's a perception that the executive branch has dropped the ball, their support is not as strong. There are a number of bills and fixes being debated.

Obama will delay expiration notices
'We will see millions more people sign up'
Obamacare numbers fail to impress

That won't be easy, though. That's in part because no insurance plan sticks around forever. Plans change from year to year, premiums change from year to year, coverage changes from year to year, and deductibles, copays, and co-insurance change from year to year. They always have. It has never been the case that you could be guaranteed that your plan would exist -- as it does today -- for as long as you would like. I've had plans I've liked canceled many times in my 10 years working at my current job.

One bill being put forth in the House would allow insurers to continue to offer plans that have been discontinued due to the Affordable Care Act. The problem with that is that many insurance companies don't want to continue to offer those plans indefinitely. They don't make sense financially. Therefore, passing this law won't stop millions of Americans from getting cancellation notices anyway.

A different bill in the Senate would force insurance companies to continue to offer those plans or leave the state entirely. If you thought the Affordable Care Act was a government takeover before, this bill is much, much worse. It would compel insurance companies to comply with a whole new host of potentially unprofitable regulations.

The truth of the matter is there is no easy solution here. Disrupting the current system isn't a bug of health care reform; it's a feature. It's what was supposed to happen. All reform will do so. Even Republican proposals, like Sen. John McCain's when he was running for president, to change the health insurance tax deduction, would have completely upended the employer-sponsored health insurance system. Then-Sen. Obama attacked him savagely for just that back in 2008.

It's fine for President Clinton and others to just "demand" this be fixed. Unfortunately, it can't be, at least not easily and not cheaply. Letting healthy people keep these plans (because most of those in the pre-Affordable Care Act individual market are healthier) and stay out of the exchanges will raise the premiums for everyone else, and thus the amount the government will have to pay in subsidies. Forcing insurance companies to continue to offer old plans in a new marketplace could wind up hurting their bottom line significantly.

Obama's administrative fix, much like the House bill, allow plans offered this year to remain in place if people want them. But that will just shift blame to the insurance companies when they cancel them. For many of the reasons above, they won't want to keep them going.

The real problem here, and one that few are addressing, is that the old health care system isn't that good. We wanted to change it. Doing so means that it, well, changes. If we liked our old health care system, we could keep it. But we didn't, and so at some point we're going to have to accept a new one.

Follow us on Twitter @CNNOpinion.

Join us on Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Aaron Carroll.

ADVERTISEMENT
Part of complete coverage on
updated 1:54 PM EDT, Sun August 31, 2014
Carlos Moreno says atheists, a sizable fraction of Americans, deserve representation in Congress.
updated 12:25 PM EDT, Sun August 31, 2014
Julian Zelizer says Democrats and unions have a long history of mutual support that's on the decline. But in a time of income inequality they need each other more than ever
updated 12:23 AM EDT, Sun August 31, 2014
William McRaven
Peter Bergen says Admiral William McRaven leaves the military with a legacy of strategic thinking about special operations
updated 12:11 PM EDT, Fri August 29, 2014
Leon Aron says the U.S. and Europe can help get Russia out of Ukraine by helping Ukraine win its just war, sharing defense technologies and intelligence
updated 1:24 PM EDT, Fri August 29, 2014
Timothy Stanley the report on widespread child abuse in a British town reveals an institutional betrayal by police, social services and politicians. Negligent officials must face justice
updated 9:06 PM EDT, Fri August 29, 2014
Peter Bergen and David Sterman say a new video of an American suicide bomber shows how Turkey's militant networks are key to jihadists' movement into Syria and Iraq. Turkey must stem the flow
updated 11:16 AM EDT, Thu August 28, 2014
Whitney Barkley says many for-profit colleges deceive students, charge exorbitant tuitions and make false promises
updated 10:34 AM EDT, Fri August 29, 2014
Mark O'Mara says the time has come to decide whether we really want police empowered to shoot those they believe are 'fleeing felons'
updated 10:32 AM EDT, Thu August 28, 2014
Bill Frelick says a tool of rights workers is 'naming and shaming,' ensuring accountability for human rights crimes in conflicts. But what if wrongdoers know no shame?
updated 10:43 PM EDT, Thu August 28, 2014
Jay Parini says, no, a little girl shouldn't fire an Uzi, but none of should have easy access to guns: The Second Amendment was not written to give us such a 'right,' no matter what the NRA says
updated 1:22 PM EDT, Sat August 30, 2014
Terra Ziporyn Snider says many adolescents suffer chronic sleep deprivation, which can indeed lead to safety problems. Would starting school an hour later be so wrong?
updated 9:30 AM EDT, Fri August 29, 2014
Peggy Drexler says after all the celebrity divorces, it's tempting to ask the question. But there are still considerable benefits to getting hitched
updated 2:49 PM EDT, Fri August 29, 2014
The death of Douglas McAuthur McCain, the first American killed fighting for ISIS, highlights the pull of Syria's war for Western jihadists, writes Peter Bergen.
updated 6:42 PM EDT, Tue August 26, 2014
Former ambassador to Syria Robert Ford says the West should be helping moderates in the Syrian armed opposition end the al-Assad regime and form a government to focus on driving ISIS out
updated 9:21 AM EDT, Wed August 27, 2014
Ruben Navarrette says a great country does not deport thousands of vulnerable, unaccompanied minors who fled in fear for their lives
updated 9:19 AM EDT, Wed August 27, 2014
Robert McIntyre says Congress is the culprit for letting Burger King pay lower taxes after merging with Tim Hortons.
updated 7:35 PM EDT, Tue August 26, 2014
Wesley Clark says the U.S. can offer support to its Islamic friends in the region most threatened by ISIS, but it can't fight their war
updated 4:53 PM EDT, Tue August 26, 2014
America's painful struggle with racism has often brought great satisfaction to the country's rivals, critics, and foes. The killing of Michael Brown and its tumultuous aftermath has been a bonanza.
updated 3:19 PM EDT, Tue August 26, 2014
Rick Martin says the death of Robin Williams brought back memories of his own battle facing down depression as a young man
updated 11:58 AM EDT, Tue August 26, 2014
David Perry asks: What's the best way for police officers to handle people with psychiatric disabilities?
updated 3:50 PM EDT, Mon August 25, 2014
Julian Zelizer says it's not crazy to think Mitt Romney would be able to end up at the top of the GOP ticket in 2016
updated 4:52 PM EDT, Mon August 25, 2014
Roxanne Jones and her girlfriends would cheer from the sidelines for the boys playing Little League. But they really wanted to play. Now Mo'ne Davis shows the world that girls really can throw.
updated 5:04 PM EDT, Mon August 25, 2014
Kimberly Norwood is a black mom who lives in an affluent neighborhood not far from Ferguson, but she has the same fears for her children as people in that troubled town do
updated 5:45 PM EDT, Fri August 22, 2014
It apparently has worked for France, say Peter Bergen and Emily Schneider, but carries uncomfortable risks. When it comes to kidnappings, nations face grim options.
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT