The Affordable Care Act has gotten little presidential debate love this election cycle though candidates generally have supported or opposed it along party lines with Clinton promising to improve it and Trump promising to repeal it. However, some of the discussion coming from both sides has lacked transparency and/or accuracy.
With facts sometimes being swept under the carpet, twisted, or misunderstood, the disturbing possibility looms that decisions around the health law will be made without proper consideration of the facts, by voters and politicians alike.
On the one hand, Democrats are getting criticism for trying to gloss over a particular issue around this year's ACA benchmark plan premium increases, which average 25%. It's not good but it's not the worst, and this election cycle serves as a reminder how easily perceptions can get distorted in the absence of facts.
Even though HHS estimates 85% of ACA enrollees will qualify for subsidies and thereby be shielded from those price hikes, that still leaves millions who will not be shielded. The number of people who will face real price hikes is estimated at 7 to 12 million, reported Vox, which noted that Bill Clinton has been one of very few Democrats to call out that problem. Vox also pointed out that the scope of the issue remains largely unknown, with the current estimates based somewhat on guesswork.
But 2017 is going to be a critical year for the exchanges. The reinsurance and risk corridor programs – created in part to help offset costs for insurers as the newly-created marketplace stabilizes – are both ending this year. Like the number of young invincibles that sign up for the exchanges, the impact on these confluences is too soon to tell as open enrollment period is only just beginning next week.
Still, the premium increases don't do any favors for the Obama administration which is working to attract and enroll more individuals this year. Aetna CEO Mark Bertolini chimed in on the premium increase this week, conceding that as rates rise, the costs aren’t worth it to healthy people, and arguing the fierce cycle of premium increases and worsened risk pool will continue until regulations are changed.
Meanwhile, Republican criticisms of the ACA are indeed being shaded by comments from GOP presidential candidate Donald Trump, who this week raised increasing concern around whether he actually understands the health law that he promises to repeal if he becomes president.
Trump's comments included that the announced 25% average rate hike is "phony" and "more like 80-90%." He also complained that "all" his employees are having problems with Obamacare, while later saying "I don't much use Obamacare" because it's so bad for people. Trump opponents argued the statements reveal a lack of knowledge around how the ACA is used and works, because the majority of Trump's employees receive employer-sponsored health coverage and employers do not "use" Obamacare, like a plan to offer employees.
The phrasing of Trump's comments not only makes it unclear whether Trump understands the health law or not, as opponents argued, but potentially adds to public misunderstanding around the health law–with little time to clear things up before November brings both the election and ACA enrollment.
As argued by Charles Gaba of ACASignups.net, it doesn't help anyone to minimize or ignore the issues with the ACA, any more than it helps when opponents exaggerate the issues. "In short: If a number is 25, saying it's 0 is just as inaccurate as claiming it's 50," Gaba wrote.