Life after the individual mandate

Iowans are quickly finding out about health care in a post-Obamacare world.

Federal and state governments have chipped away at the 2010 law for years, with the pace picking up in 2017 when Republicans took full control of the federal government. President Donald Trump signed an executive order directing agencies to wind down the Obama-era regulations, and Congress passed a bill repealing some portions of the Affordable Care Act.

Supporters of the reforms say they will give health care consumers more options, while critics say they will make it more difficult to provide care for the neediest Americans. They both may be right.

Iowa is at the forefront in part of the movement to sidestep the ACA. Lawmakers passed legislation this year to allow the Farm Bureau to offer limited health plans with fewer benefits. Such services are sold outside the regulatory structure imposed by the Obama administration.

A report published this month by the left-leaning think tank Center on Budget and Policy Priorities singled out Iowa for what it calls 'skimpy health plans” targeted at uninsured farmers, which the group says are 'inadequate and unaffordable.”

The Trump administration is also easing restrictions on other health coverage products, like short-term plans and association health plans, which do not adhere to ACA standards.

And perhaps most important of all, Congress repealed the individual mandate as part of the tax cut package Trump signed into law at the end of 2017. That part of the ACA required all Americans to have health insurance or face a steep tax penalty. Architects of the ACA said it was crucial, since their plan relied on mandating everyone to participate in the government-regulated health insurance system.

During his visit to Iowa last week, Trump took credit for nixing the individual mandate.

'Even included in that bill is the individual mandate. We got rid of the individual mandate, the most unpopular thing in Obamacare, and Obamacare is on its way out. You look at the costs of Obamacare, it's horrible. … It's on its last legs right now,” Trump said during a meeting in Peosta, with Gov. Kim Reynolds and U.S. Rep. Rod Blum seated nearby.

Trump also vaguely referenced other recent and forthcoming regulatory changes. He promised, 'You get tremendous health care at a very small cost.”

A common theme in the left's response to the Republicans' recent health care reform plans is the argument they will incentivize too many healthy people to leave the ACA-approved system to find alternative models of health coverage. Without those people paying premiums and not needing much care, everyone else's premiums will be higher.

'For everyone who gains, other people will be harmed. People enrolled in standard, comprehensive individual market plans will see their premiums rise as healthier people flock to the less generous plans subject to weaker standards and leave a costlier risk pool behind,” authors wrote in the recent Center on Budget and Policy Priorities report on Iowa's 'skimpy” health plans.

During last year's federal health care debate, some media outlets and liberal critics said ending the individual mandate would lead to 13 million losing their health care coverage, based on estimates from government policy analysts. That's a creative way of saying an estimated 13 million people would choose not to participate in the federally regulated health insurance system.

You may notice this argument is about young people, but seldom made by young people. Policymaking as usual.

As Trump famously observed last year, health care is 'an unbelievably complex subject.” Health care decisions by one group of people do indeed impact care and costs for other people, as ACA supporters point out. Yet the ACA did little to contain overall health care costs, and instead simply mandated that we all share in the costs.

As Americans grow older, they consume more medical resources. Everyone else subsidizes that care with the expectation someone else will subsidize their care when and if they should need it.

That same principle in Medicare has created a tremendous burden of government debt and unfunded liabilities. A 2015 report from the Urban Institute showed a typical couple earning average wages would pay in nearly $700,000 to Social Security and Medicare over their lifetimes, but receive more than $1 million in benefits.

Eventually there may not be enough young, healthy people to pay for the older generation's health care in either the insurance market or the public systems. When I was born in 1990, there were 3.4 workers for every Social Security beneficiary. Now, that number is closing in on 2 workers per beneficiary.

Right now, Americans 65 and older account for about 15 percent of the population, according to federal Census figures. By the time I turn 65, older Americans are estimated to make up nearly a quarter of the population. Someone will have to pay for our care.

If you're a younger American, I suggest you start saving now.

' Comments: (319) 339-3156; adam.sullivan@thegazette.com