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 4:06 PM EDT, Tue October 21, 2014
Timothy Stanley says Lewinsky is shamelessly playing the victim in her affair with Bill Clinton, humiliating Hillary Clinton again and aiding her critics
updated 9:02 PM EDT, Mon October 20, 2014
Imagine being rescued from modern slavery, only to be charged with a crime, writes John Sutter
updated 12:00 PM EDT, Tue October 21, 2014
Tidal flooding used to be a relatively rare occurrence along the East Coast. Not anymore, write Melanie Fitzpatrick and Erika Spanger-Siegfried.
updated 7:35 AM EDT, Tue October 21, 2014
Carol Costello says activists, writers, politicians have begun discussing their abortions. But will that new approach make a difference on an old battleground?
updated 9:12 AM EDT, Tue October 21, 2014
Sigrid Fry-Revere says the National Organ Transplant Act has caused more Americans to die waiting for an organ than died in both World Wars, Korea, Vietnam, Afghanistan and Iraq
updated 2:51 PM EDT, Tue October 21, 2014
Crystal Wright says racist remarks like those made by black Republican actress Stacey Dash do nothing to get blacks to join the GOP
updated 6:07 PM EDT, Tue October 21, 2014
Mel Robbins says by telling her story, Monica Lewinsky offers a lesson in confronting humiliating mistakes while keeping her head held high
updated 9:29 AM EDT, Mon October 20, 2014
Cornell Belcher says the story of the "tea party wave" in 2010 was bogus; it was an election determined by ebbing Democratic turnout
updated 4:12 PM EDT, Mon October 20, 2014
Les Abend says pilots want protocols, preparation and checklists for all contingencies; at the moment, controlling a deadly disease is out of their comfort zone
updated 11:36 PM EDT, Sun October 19, 2014
David Weinberger says an online controversy that snowballed from a misogynist attack by gamers into a culture war is a preview of the way news is handled in a world of hashtag-fueled scandal
updated 8:23 AM EDT, Mon October 20, 2014
Julian Zelizer says Paul Krugman makes some good points in his defense of President Obama but is premature in calling him one of the most successful presidents.
updated 10:21 PM EDT, Sun October 19, 2014
Conservatives can't bash and slash government and then suddenly act surprised if government isn't there when we need it, writes Sally Kohn
updated 8:28 AM EDT, Mon October 20, 2014
ISIS is looking to take over a good chunk of the Middle East -- if not the entire Muslim world, write Peter Bergen and Emily Schneider.
updated 9:00 AM EDT, Mon October 20, 2014
The world's response to Ebola is its own sort of tragedy, writes John Sutter
updated 4:33 PM EDT, Fri October 17, 2014
Hidden away in Russian orphanages are thousands of children with disabilities who aren't orphans, whose harmful treatment has long been hidden from public view, writes Andrea Mazzarino
updated 1:22 PM EDT, Sat October 18, 2014
When you hear "trick or treat" this year, think "nudge," writes John Bare
updated 12:42 AM EDT, Sat October 18, 2014
The more than 200 kidnapped Nigerian schoolgirls have become pawns in a larger drama, writes Richard Joseph.
updated 9:45 AM EDT, Fri October 17, 2014
Peggy Drexler said Amal Alamuddin was accused of buying into the patriarchy when she changed her name to Clooney. But that was her choice.
updated 4:43 PM EDT, Thu October 16, 2014
Ford Vox says the CDC's Thomas Frieden is a good man with a stellar resume who has shown he lacks the unique talents and vision needed to confront the Ebola crisis
updated 4:58 AM EDT, Sat October 18, 2014
How can such a numerically small force as ISIS take control of vast swathes of Syria and Iraq?
updated 9:42 AM EDT, Fri October 17, 2014
How big a threat do foreign fighters in Syria and Iraq pose to the West? It's a question that has been much on the mind of policymakers and commentators.
updated 8:21 AM EDT, Fri October 17, 2014
More than a quarter-million American women served honorably in the Iraq and Afghanistan wars. Now they are home, we have an obligation to help them transition back to civilian life.
updated 4:27 PM EDT, Thu October 16, 2014
Paul Begala says Rick Scott's deeply weird refusal to begin a debate because rival Charlie Crist had a fan under his podium spells disaster for the Florida governor--delighting Crist
updated 12:07 AM EDT, Thu October 16, 2014
The longer we wait to engage on Ebola, the more limited our options will become, says Marco Rubio.
updated 7:53 AM EDT, Wed October 15, 2014
Democratic candidates who run from President Obama in red states where he is unpopular are making a big mistake, says Donna Brazile
updated 12:29 AM EDT, Thu October 16, 2014
At some 7 billion people, the world can sometimes seem like a crowded place. But if the latest estimates are to be believed, then in less than a century it is going to feel even more so -- about 50% more crowded, says Evan Fraser
updated 12:53 PM EDT, Mon October 20, 2014
Paul Callan says the Ebola situation is pointing up the need for better leadership
updated 6:45 PM EDT, Wed October 15, 2014
Nurses are the unsung heroes of the Ebola outbreak. Yet, there are troubling signs we're failing them, says John Sutter
updated 1:00 PM EDT, Wed October 15, 2014
Dean Obeidallah says it's a mistake to give up a business name you've invested energy in, just because of a new terrorist group
updated 7:01 PM EDT, Wed October 15, 2014
Fear of Ebola is contagious, writes Mel Robbins; but it's time to put the disease in perspective
updated 1:44 PM EDT, Tue October 14, 2014
Oliver Kershaw says that if Big Tobacco is given monopoly of e-cigarette products, public health will suffer.
updated 9:35 AM EDT, Sat October 18, 2014
Stop thinking your job will make you happy.
updated 10:08 PM EDT, Tue October 14, 2014
Ruben Navarrette says it's time to deal with another scandal involving the Secret Service — one that leads directly into the White House.
updated 7:25 AM EDT, Tue October 14, 2014
Americans who choose to fight for militant groups or support them are young and likely to be active in jihadist social media, says Peter Bergen
updated 9:03 AM EDT, Mon October 13, 2014
Stephanie Coontz says 11 years ago only one state allowed same sex marriage. Soon, some 60% of Americans will live where gays can marry. How did attitudes change so quickly?
updated 4:04 PM EDT, Tue October 14, 2014
Legalizing assisted suicide seems acceptable when focusing on individuals. But such laws would put many at risk of immense harm, writes Marilyn Golden.
updated 9:07 AM EDT, Mon October 13, 2014
Julian Zelizer says the issues are huge, but both parties are wrestling with problems that alienate voters
updated 6:50 PM EDT, Mon October 13, 2014
Mel Robbins says the town's school chief was right to cancel the season, but that's just the beginning of what needs to be done
updated 11:43 AM EDT, Sat October 11, 2014
He didn't discover that the world was round, David Perry writes. So what did he do?
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT