WebMD Affordable Care Act (ACA) and health insurance expert Lisa Zamosky sat down this week with President Barack Obama to discuss the ACA. Ms. Zamosky's questions for the President were gathered from WebMD's readers, many of whom expressed continued confusion over the details and impact of the law. Consumers from all 50 states weighed in, expressing concerns about the affordability of health insurance, problems with the federal exchange site, healthcare.gov, high insurance deductibles, and the reluctance of some states to expand Medicaid.
Below is an excerpt from the discussion.
Putting the "Affordable" in the Affordable Care Act
Lisa Zamosky, MSW: Mr. President, thank you so much for sitting down to talk with us.
President Barack Obama: Lisa, thank you for having me.
Ms. Zamosky: We invited the WebMD community to submit questions for you about the Affordable Care Act, and we got a huge response. We received questions from people from all 50 states.
President Obama: Let's dive in.
Ms. Zamosky: We received literally hundreds of questions from people like Becky from Maryland, Connie from Pennsylvania, and Tiffany from Tennessee, who believe that they need to make a choice between buying health insurance and paying for other necessities.
What can you say to people who believe that health insurance still isn't affordable, and they're concerned that if they don't purchase it, they'll have to pay a penalty?
President Obama: Well, the first thing is making sure everybody has the right information, because there's been so much politics swirling around this, that I think a lot of folks still aren't sure what exactly is available.
My most important recommendation is for people to go to the Website -- healthcare.gov -- and look for themselves at what plans are being provided.
The Website helps you calculate whether or not you qualify for a tax credit. If you do qualify for a tax credit, then I think a lot of people may end up being pleasantly surprised because, for a large portion of those folks, health insurance may end up costing $100 or less [per month]. It may end up costing less than your cable bill or your cell phone bill. And, you know, if you are young, it may end up costing as little as $50 [per month] for good, solid coverage, that not only protects you in the case of illness or accident but also allows you to get free preventive care, like routine mammograms or making sure that you're getting your flu shot for you and your family.
In some cases, people may also find out that, if they're really suffering some financial hardships, that they qualify for Medicaid, or that their children qualify for the Children's Health Insurance Program -- all of which give them high-quality health insurance.
And finally, if in fact they still can't afford it, there is a hardship exemption in the law. That means that they may not be subject to a penalty.
Why Are Deductibles so High?
Ms. Zamosky: We also heard from some other folks who have taken the time to go on the Website. We got a question, for example, from Rose in New Jersey. She says she qualifies for a subsidy and she actually seems pretty pleased with the premium that she's paying for insurance. But she asks this: "If the purpose of the Affordable Care Act is to ensure that all Americans have healthcare, why do most plans have such a high deductible?"
President Obama: Well, essentially what we've done is to create a marketplace for private insurance. And each insurer is pricing it. Some have lower deductibles but that means, then, that it may be a higher premium. Some of them may have higher copays but a lower premium. And so, what we've tried to do is to say, "Here are a range of options that are available to you through traditional private providers, and you choose what you think is best for you."
Now, you know, obviously there are other countries that have government-run healthcare or that have a single-payer plan, in which case the government really controls much more tightly how healthcare is distributed.
There are pluses and minuses with having a private insurance system, but what we have tried to do is to make sure that everybody has a range of options and that they can see what's going to be most suited for their family.
Why Aren't More States Expanding Medicaid?
Ms. Zamosky: You mentioned Medicaid. Obviously, as you know, there are millions of people living in states that have chosen not to expand Medicaid. We heard from folks like Emily in Alaska, Sarah from Texas, and Pat from Georgia, and Pat says that she hardly makes enough money to pay her bills. She asked, "Is it possible for me to get coverage or am I one of the forgotten?" And Steven from North Carolina asks a little more pointedly, "Can't you reinstate the Medicaid expansion by executive order?"
President Obama: This is a source of great frustration for me, because what the law does is expand Medicaid for just the folks that wrote you those letters, and the federal government is giving states a 100% match, meaning the state won't have to put out any outlays and your citizens will be insured. And for political reasons, a number of the states have chosen not to take us up on that. And the Supreme Court said we could not [force] them to accept it. So we don't have the ability, at the federal level, to pressure these states to do what they should be doing.
Hopefully, citizens in those states, as they look at neighboring states that are expanding Medicaid, will say, "Well, why would you, Mr. Governor, or members of the state legislature, choose deliberately to leave people in our states uninsured, particularly when it doesn't cost the state any money?" So, in the interim, the best we can do for those unfortunate folks who are caught in this situation is to say to them that they will not be subject to a penalty for not getting health insurance. It's not their fault that the state is not doing what it should do. But in the meantime, that means that they're still relying on emergency room care or a free clinic, or just foregoing care, which is bad policy and it's bad for those families.
When It's Cheaper to Pay a Penalty
Ms. Zamosky: We also had a number of people, like Jane from Washington state, who [aren't] planning on purchasing a plan because, again, of the issue of cost. She says it's cheaper to pay the penalty. If a lot of Americans follow Jane's lead, people want to know what impact this will have on the ACA.
President Obama: Well, at this point, enough people are signing up that the Affordable Care Act is going to work. The insurance companies will continue to offer these plans. We already have over 4 million people signed up. It will be a larger number than that by the end of March 31, the deadline to get insurance this year. If you miss the deadline, by the way, on March 31, you can get insurance but you'll have to wait until November of this year to start signing up again.
The number of people who have signed up is already large enough that I'm confident the program will be stable, but we look forward to seeing more and more people take advantage of it as some of the politics of the thing get drained away, as people start feeling more confident about the Website, as folks like you spread the word in terms of giving people accurate information. Then, over time, I think a lot more people are going to take advantage of it.
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Cite this: Obama Responds: WebMD Readers Ask Tough ACA Questions - Medscape - Mar 14, 2014.