Rod St. Aubyn: Where Are Obamacare's Health Care Cost Savings?


I’m sure many have seen the recent news story of the Minnesota restaurant that started to charge and display on the receipt a new surcharge for the cost of the recently passed minimum wage increase. I have often wished that health insurers were required to itemize on their premium notices the new costs that are the result of the so-called Affordable Care Act (ACA). Though it may be difficult to actually calculate, it would be informative.

Proponents of the ACA argued that it would reduce health care costs and save families over a couple of thousand dollars per year. To the contrary, implementation of the ACA has done little to reduce health care costs. Granted with the subsidies some health consumers have seen some financial benefits, but where are the overall savings in health care costs?

That was one of my main reasons for opposition to this proposal that could only pass in the Congress by using some rarely used parliamentary procedure with absolutely no minority support. There is little in the ACA that will or has actually reduced health care costs. Instead it just provides subsidies to some, increases benefits thus increasing premium costs, and in many cases reduces consumer choices. And we wonder why the majority of the public still does not support this sweeping change?

I don’t know how anyone can deny that the rollout of the ACA has been anything but a disaster. Initially a failed Federal Exchange, many failed State-based Exchanges, and many delayed federal regulations to clarify the ACA have resulted in a system of confusion and frustration. Now we have two conflicting legal decisions on challenges to subsidies for those on the Federal Exchange. We will have to wait to see if the Supreme Court will take up this issue. If they rule that subsidies are not permitted for those getting coverage in the Federal Exchange (such as ND and 35 other states), will those in ND and those other states receiving subsidies in 2014 and 2015 have to pay back their subsidies? Add one more item to the list of confusions.

North Dakotans had many more health insurance options available prior to the implementation of the ACA. Now only 3 insurers (Blue Cross Blue Shield of ND, Sanford Health Insurance, and Medica) offer insurance in the Exchange. Several other national insurers declined to enter the ND market. So what happened to consumer choice? This has been another negative consequence of the ACA.

Now I get back to affordability. We have not seen any evidence in ND of premium cost reductions. In fact, after discussions with many health insurance insiders they expect Exchange products in ND to again increase in the two digit percentage for 2015. I sincerely hope that

these insiders are wrong; however I suspect that they will be right.

The insurance industry is highly regulated to control health insurance premiums. These premiums are now regulated by both the State and the Federal government. But how are premiums used – to pay for services provided by medical providers, prescription drugs, and hospitals. And consumers drive those services. Not that I support additional regulatory authority, but who regulates what medical providers and the pharmaceutical industry charge for their services? Normally in a free market situation, competition controls costs. However in the medical field in a rural small populated state, competition is simply not realistic. Should we have two hospitals in the rural communities where the current hospital is most likely operating at a loss? What type of medical care do ND residents expect within our medical facilities? Should the entire myriad of medical services be available in each facility? If not, what are the minimum services that should be available?

No one can deny that we do have a health care system that needs improvement. Some components within the ACA are good and have public support. However, as a whole the ACA is not the answer. I am a strong state’s rights advocate and feel that North Dakotans could find their own solution that would work for the betterment of its citizens. In a follow up blog I will offer some ideas to consider. In the meantime, when you get your next premium notice for 2015 ask yourself – How much was this increase due to the “Affordable” Care Act which was promised to reduce health care costs?