In early 2013, I quit a full-benefits staff job to freelance. Some months after that, I signed up for Obamacare.
The insurance plan I bought through New York state's marketplace exchange was all right. The coverage was about the same as I'd had with my employer-provided insurance, but it cost about 30 percent more. It's difficult to know why. Was the marketplace a less competitive bargainer than my old company had been? Or had the Affordable Care Act raised my former co-workers' premiums too? Either way, I felt that, without the act, a similar plan would have cost even more for me as a freelancer. I was grateful.
So when Republican presidential hopeful Scott Walker released his plan for replacing the Affordable Care Act on Tuesday, I was interested to read what my fate would have been under his plan. Would Walkercare have been better or worse?
Conservatives want market forces to determine what insurance plans look like, with the idea that competition will get companies to develop good plans.
Keep in mind my experience with Obamacare was probably common, but not the majority experience. According to a recent Gallup poll, Americans of my age and income level are among the most likely to tell surveyors that indeed the Affordable Care Act helped them. The majority of Americans overall, however, said the act had no effect on their families. And folks who are 30 or older, make $24,000 or more, and are white were more likely to say the Affordable Care Act hurt them than to say it helped.
My thoughts on Walkercare, as I read through the short document:
- I had to click three different "Read My Plan" buttons on scottwalker.com before actually reaching the PDF. The first button served only to take me from a page that said, "Repeal and Replace ObamaCare" to a very similar-looking page that said, "THE PLAN TO Repeal & Replace ObamaCare."
Then again, the Affordable Care Act website was poorly implemented at first too, and that was much more important.
- In its introduction, the Walker document claims the Affordable Care Act "drove up health care costs and reduced access to medical care for far too many of our neighbors, friends, and family members." In fact, the rate of growth in America's health-care spending was already declining at the time the Affordable Care Act passed, due to worldwide trends, such as the poor economy and drug patents expiring. Analysts generally agree that the Affordable Care Act helped with the spending slowdown, although they debate by how much.
In addition, the act encouraged 10 million previously uninsured Americans to sign up for a plan. These are all people who now have increased access to medical care.
- There's a part in Walker's plan that talks about people "without employer-sponsored health insurance." That's me! Well, the former me. Walker plans to offer tax credits, which, on the consumer end, would feel the same as the subsidies Obamacare provides. Walker proposes to pin the credits to age, not income, with bigger credits for older folks. The National Review explains such credits are enough to allow everybody to get catastrophic coverage for free. (Insurance premiums generally go up for older folks.) But why not calculate this tax credit with age and income, as Obamacare does? Doing so might help eliminate wasting credits on higher-earning individuals.
- Much of Walker's plan talks about giving states more power over insurance marketplaces and rules than Obamacare does, which is in line with the general GOP philosophy. Whether Walkercare is better than Obamacare, then, might depend on where you live. For example, states would run Medicaid, and would have more flexibility to extend, contract, or keep the popular provision of the Affordable Care Act allowing children to stay on their parents' health plans until age 26.
Walker says giving states power will streamline health insurance and create the savings he'll need to pay for his plan. However, without detailed accounting, it's impossible to know how much this plan will cost, and whether Walker would be able to cover it without taxes, as he's promised.
- Walker's plan encourages people to use Health Savings Accounts, which are special, tax-free funds that people can put money into and withdraw from for health-care purchases. They're designed to encourage people to spend more wisely, since they're using their own money. This would likely work for many—but not all—people. A 2005 Government Accountability Office report found that those who used Health Savings Accounts were generally satisfied, but still didn't recommend them to everyone. The young and healthy and those near retirement are the most likely to benefit.
- The Walker plan is missing some protections Obamacare offers, Time reports. For example, there's no cap to out-of-pocket costs and no prohibitions against charging women more, which insurance companies often did before the Affordable Care Act, because women sometimes require maternity care. That pattern could return.
The National Review notes the missing protections are emblematic of the divide in how conservatives and liberals see the role of health insurance. The liberal Affordable Care Act has lots of rules about what health insurance should look like, including a requirement that birth control be free and forbidding gender bias in pricing. Conservatives want market forces to determine what insurance plans look like, with the idea that competition will get companies to develop good plans (while very bad plans might be available, too, for a low price).
So what's the score? Without a detailed budget, it's hard to know whether Walkercare would cost me more or less. It's pretty clear, though, that many provisions in Obamacare are made to benefit me and those like me. Coverage for birth control and the elimination of gender-based pricing are great for young women like me. Because of my income and the high cost of living in my area, I also got a heftier Obamacare subsidy than my age-based Walkercare tax credit would be. What will others see when they read through the plan? That I can't answer.