(Bloomberg View) — The U.S. health care system has been squeezing the country’s middle class for years. The passage of the Patient Protection and Affordable Care Act (PPACA) has relieved some of the pressure, but there’s much more to do.
With or without Obamacare, the issues are the same: access and cost. If losing your job also means losing your health insurance, you face a whole new kind of economic insecurity. And even if you have good insurance through your employer and aren’t afraid of losing it, the ever-rising cost of health care is steadily eating away at your wages. The assurance of adequate coverage and better cost control would make a real difference to Americans of ordinary means.
Far more than its critics acknowledge, Obamacare has helped a lot. To widen access, it pays for states to expand Medicaid; ensures private insurers accept all customers and cover a range of care; and provides subsidized insurance for those who earn up to four times the official poverty level. The reform has cut the share of American adults without insurance to 12 percent from 17 percent since the end of 2013. That’s a notable achievement.
Even so, about 30 million adults remain uninsured. Three-quarters of them lack access to coverage that meets the government’s definition of affordable. An estimated 10.5 million people whose incomes are low enough to qualify for subsidies are deemed ineligible because they decline their employer’s coverage — in many cases, presumably, because it’s too expensive. Many older Americans are in a similar fix: They make too much to qualify for subsidies but can’t find insurance they can afford.
Turning to cost, the average premium for job-based insurance last year was $16,834 per family, 69 percent higher than a decade earlier. That’s money that can’t go toward wages, pensions or other benefits. Granted, premiums have grown more slowly since the law was passed, but it isn’t yet clear how much of that slowdown is due to greater efficiency as opposed to the recession and its aftermath.