Affordable Care Act: Fix One Thing, Break Another?

One of the goals of the ACA was to end coverage discrimination for preexisting conditions. However, even if it is unintended, the ACA does still discriminate against other groups.
One of the goals of the ACA was to end coverage discrimination for preexisting conditions. However, even if it is unintended, the ACA does still discriminate against other groups.

During the roll out of the Affordable Care Act (ACA, or “Obamacare”), people often asked me if I thought it was a good thing or a bad thing.  I responded that, as with any document that is 2700 pages long—plus an additional 20,000 pages of regulation—likely there would be some good things and some that were not so beneficial. No one bill or change to health care funding and regulation, no matter how massive, could possibly be all good or all bad. More than likely, it would fall somewhere in the middle.

One of the goals of the ACA was to end coverage discrimination for preexisting conditions. Clearly, the ACA has been effective in this regard, and I truly applaud and approve of that provision. However, even if it is unintended, the ACA does still discriminate against other groups.

The group most discriminated against by the ACA is seniors. As of January 2015, the cost for group health insurance premiums is determined mostly by employee age and family size.  Prior to that, coverage for an employee in his or her 20s cost an employer the same as for an employee who was 60 years old. With the new age-based premiums, coverage for a 60-year old employee now can cost as much as three times more than for a 20-year old employee.

There's an obvious potential here for an aging population of baby boomers already struggling to prove their worth in an employment marketplace that continues to get younger, to find it even harder to find and keep jobs. And there is the danger that the considerable experience, knowledge and wisdom of our countries seasoned workers would be untapped and lost to companies.

True, the ACA tried to contain age discrimination by limiting the maximum premium ratio to 3:1. (Ironically, the ACA protects smokers better than seniors. The maximum premium ratio for smokers is set at 1.5:1.)

The ACA also discriminates against employees with large families. Before January 2015, a family of 3 paid the same premium as a family of 6.  Now that coverage for a family of 6 costs significantly more.

All of which is to say that, even with changes that do make some things better, it's critical to be alert to what else is affected—that “improvement” might make something else worse. Hopefully the positive aspects of the ACA will outweigh the negative ones, especially as so much is at stake. Time will tell—the jury is still out and likely will be for a long time.

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