10 years ago today, on the first anniversary of the Affordable Care Act (ACA), I wrote about the good things the law did, but stressed that we needed to view it as only the starting point of a journey toward needed reform. Unfortunately, we have not made much progress on that journey.

Although 20 million now have health insurance as a result of the law, a huge growing percent can’t use that insurance to get the care they need. That’s because Congress and the Obama administration were too focused on premiums … exactly what the insurance industry wanted them to focus on!

Focusing on premiums meant that Democrats gave scant attention to how insurers would pick Americans’ pockets by jacking up deductibles year after year. In fact, deductibles are patients’ biggest struggle now, more than having enough doctors in-network, or even the price of premiums.

Zeke Emanuel, who advised Obama on health policy, recently told The New York Times that not addressing deductibles was “a huge mistake.” While Congress just passed a $1.9 trillion Covid-19 relief bill, Emanuel said they were under pressure in 2010 to keep the price of ACA under $1 trillion.

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People in high-deductible plans don’t go to the doctor when they should, or pick up their prescriptions because of the thousands they pay out of pocket before insurance kicks in. Meanwhile, insurance companies posted record profits every year since the ACA was passed, even during COVID!

“People in high-deductible plans don’t go to the doctor when they should, or pick up their prescriptions because of the thousands they pay out of pocket before insurance kicks in.”

As growing numbers of Americans skip needed care, those insurers are paying their top executives, like David Cordani, the CEO of Cigna, where I used to work, astronomical salaries. The company noted in a filing last week Cordani’s pay totaled $79 million.

Cigna executives were saying back when I was there that Americans needed to “put more skin in the game.” Obama and Congress bought that line. It’s way past time that Cigna put skin in the game. And, it’s time that our government gives people relief so they can actually use their insurance, for once.

The Kaiser Family Foundation says that the year before the ACA was passed, most people on average were able to meet their deductibles by March 18. That was what Kaiser refers to as Deductible Relief Day. Last year Deductible Relief Day didn’t arrive until May 19.

The bottom line – this is a broken system. The ACA did a bunch of good things. But our work to fix this mess is not close to over. Not by a long shot.


Wendell Potter
Chairman of the Board at To Be Fair, Inc. | + posts

To Be Fair, Inc. and Tarbell.org founder Wendell Potter is an American consumer advocate, New York Times bestselling author, consultant, and former health insurance industry executive. A critic of HMOs and of the tactics used by insurers, Potter is also an advocate for major reforms of the industry, including universal health care.