Sen. Steve Daines pointed to large premium increases in the individual insurance market and concern for those who must pay a penalty if they forego insurance when he responded in a letter to constituents who asked him to vote against repeal of the Affordable Care Act.
We should all share Senator Daines’ sympathy for the people who are in the individual market and do not qualify for premium subsidies. Given that concern, we should then expect him to vote in a way that helps people in the individual market – but he did not.
The individual market is relatively small, insuring 5 percent to 7 percent of the U.S. population. People in the individual market do not get insurance through an employer, Medicare, Medicaid, or other government program. They include people who are self-employed, early retirees, part-time and low-wage workers, or people who lost insurance from other sources because of a life change, such as divorce, job loss, or illness. Many of these individuals struggled to afford health insurance before Obamacare because the individual insurance market was a mess. Obamacare was an effort to create a better functioning individual market that did not exclude people because they were sick with a pre-existing condition. Under Obamacare, approximately 82 percent of the people in the individual market are able to afford insurance, despite premium increases, because they qualify for premium subsidies tied to income. Daines fails to mention that in his letter.
He also exaggerates the significance of the premium increases. According to the nonpartisan Kaiser Family Foundation, although premiums went up more than expected in 2017, they had been lower in the early years of Obamacare. In 2017, premiums were at about the level that had been expected by the Congressional Budget Office when the law was enacted. Before the recent political instability, premiums had been expected to stabilize.
Daines’ letter explaining his vote to repeal Obamacare fails to mention that most people are not in the individual market and are not affected by premium increases in that market. Most people get their insurance through their employers (13 times more people than in the individual market). Most employers and their employees have seen insurance costs stabilize and moderate because of Obamacare. Premium increases in the individual market do not impact Medicare, Medicaid, or other government programs.
Daines’ vote to repeal Obamacare without a better replacement makes no sense. Senate Republican proposals that he supported also made no sense, if you were concerned about unaffordable premiums. For instance, here’s what the Senate Better Care Reconciliation Act would have meant for single, 60-year-old Montanans: Their annual net premium plus deductible would be $10,130 (41 percent of their income), compared to $2,510 (or 9 percent of income) under Obamacare, according to an Urban Institute analysis. A 60-year-old might be able to afford insurance under Obamacare, but there is no way he or she could afford insurance under what was the primary Republican proposal in the Senate.
Daines does not acknowledge that Obamacare has dramatically reduced the number of people without insurance, both through Medicaid expansion and the subsidized individual market. Repealing Obamacare, without a better alternative, would harm people who have benefited from subsidies and would make the problems Daines points to much, much worse.
If Senator Daines is going to act sensibly to help people who face unaffordable premiums in the individual market, he should work with moderates, both Republican and Democrat, to keep Obamacare running, with adequate premium subsidies, until they have a credible plan for something better. And when he writes to those of us he represents who see the good Obamacare has done, he should present the facts more honestly and justify his votes and his policy positions more credibly.
Attorney Kathy Kenyon, of Red Lodge, retired after working as a senior policy analyst from 2009 to 2015 in the U.S. Department of Health and Human Services, Washington, D.C. Previously, she served as general counsel at Billings Clinic.