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Monday, January 27, 2020  Spokane, Washington  Est. May 19, 1883
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Sue Lani Madsen: Affordable Care Act not true health care reform

UPDATED: Fri., Oct. 30, 2015

It’s open season for enrollment in health insurance if you choose to purchase it.

Not much of a choice.

Three years ago the Affordable Care Act went into effect and we all became subject to a penalty for not buying health insurance.

Yes, I know the U.S. Supreme Court redefined it as a tax, the only sales tax for not buying something. The tax has increased each year and is 2.5 percent of income for 2016, capped at $2,085 per household. Households with an income of $83,400 will hit the cap, resulting in middle-income households being taxed at a higher rate than upper earners.

Although most people will buy and few will pay the tax, it’s all part of the frustration that leads to calls to repeal Obamacare.

Personally, our family has opted out under the provisions of 26 U.S.C. §5000A(d)(2)(B)(ii). In plain English, we joined a health care sharing ministry, recognized as one of several acceptable alternatives to purchasing private insurance or signing up for public insurance.

Rising premiums and deductibles hit those of us who are self-employed or with individual policies first. Although driven out of insurance by economics, we’re blessed to have joined a community carrying out the advice in Galatians 6:2 to “Bear one another’s burdens, and so fulfill the law of Christ.” It also provides a unique vantage point for observing as the provisions of the ACA continue to slowly roll out.

The market changes have been uneven, causing further frustration with Obamacare. The Washington Office of the Insurance Commissioner’s website lists approved premium changes ranging from a decrease of 20.6 percent to an increase of 22.75 percent.

A friend recently told me premiums to renew her small-business health insurance were holding steady. For her, for now, she sees Obamacare as working fine. Another small-business owner forwarded copies of the rate sheets he’d just received from his broker. The premium for maintaining the same coverage for the same lives (one year older) will be 25.7 percent higher than the 2015 rate. He’s looking at leaving the insurance market. A self-employed neighbor told me she’s already paying over $2,000 per month for her small family, and premiums will be going up again in 2016. She has no idea what she’s going to do, but repealing Obamacare sounds appealing to her.

For households seeking private insurance, there are 136 plans offered on the Washington Health Plan Finder Exchange this season and more available off the Exchange, not all of them in every county or providing the coverage you and your family need. The most affordable plans usually have high deductibles that can sink your budget if you have a health problem; those with lower deductibles have higher monthly premiums. There are subsidies available – essentially prepaid tax credits – but be cautious. If your annual household income turns out higher than projected, you may find yourself next April 15 wishing you’d told the boss in December, “I don’t want a $500 bonus, I’ll owe the IRS $5,000.”

Open season enrollment starts Nov. 1 and runs through Jan. 31, 2016. There are trained “navigators” as well as professional insurance brokers available to help individuals find the right plan for their circumstances. But let’s skip the illusion – it isn’t as simple as buying a book on Amazon, as President Barack Obama quipped in the beginning.

If your income is low enough, you may qualify for fully subsidized health insurance under Medicaid. In Washington, we call the Medicaid program Apple Health. But let’s skip the illusion here, too, and stop calling it free health care. It has to be paid for. Quietly passed bipartisan bills tweaking the ACA have repealed the unrealistic cost cuts and unpopular new taxes Obamacare relied on for financing. Medicaid is not a sustainable program.

We still need real health care reform, whether that means starting over from scratch by repealing Obamacare or continuing from where we are. The question we have to face is how to make health care affordable no matter what mechanism is used to pay for it. The Affordable Care Act did nearly nothing to address the cost drivers of health care. Mr. President, it’s not settled policy.

Contact Sue Lani Madsen at

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