Obamacare

Well, we’re back from vacation and we spent our break playing a lot of roleplaying games and if there is one thing we have learned it is that every party needs a good healer. That is true whether you are a Level 1 Warrior or a Level 17 Civil-Engineer. However, the US Senate is looking to repeal Obamacare, aka the Affordable Care Act. So, seeing as we are back from break -with fuzzy heads and lingering colds- we thought now would be a good time to explore this keystone healer act in detail. Is it “Good?” Is it “Evil?” Or is it just “Lawful Neutral?”

Wand of Lesser Health Care
In order to explain Obamacare we need to take a look at what came in ages past. In those days of yesteryear, -2010- 1 in 6 Americans did not have health insurance. That is about 50 million uninsured people, and if they broke a leg or got deathly sick their only option was the Emergency Room and high medical bills. When these bills couldn’t be paid the costs usually got deferred by hospitals by passing it on to those of us with health insurance. That is one of the reasons why the amount we spend per person on health insurance, $8,745 -according to the Organization for Economic Co-operation and Development – is at least $4,000 more than the per-capita expenditures in countries like Australia, Canada, France, Germany, Japan, and the UK.

Before Obamacare, health insurance premiums were rising at about 10% per year. In comparison, the housing market in New York City increased by 20% between the beginning of 2001 and the end of 2010. That is about 2% on average a year, but it doesn’t stop there. Health premiums were even higher if you had a pre-existing condition, such as cancer or being a woman. In fact, the number one cause of bankruptcy in the United States was because of medical expenses. Over 75% of people declaring bankruptcy for medical bills had insurance, and -on top of all that- you could be kicked off your health insurance plan if you were sick, which sounds… absurd. An insurance company used to be able to kick you off for getting sick… you know the very thing you paid them to help you with. That would be like a Rogue who refused to disarm traps. It’s your damn job, Todd. If you didn’t want to deal with traps you shouldn’t have chosen to be the Rogue. Children were also kicked off their parent’s health insurance by the age of 24 or younger depending on individual health plans.

Since taking affect in 2010, Obamacare has righted some of these wrongs. Children can now stay on their parent’s health insurance until the age of 26. You cannot have your health insurance plan cancelled if you get sick. You cannot be charged more if you are a woman or have a pre-exisitng condition. You cannot now be denied health insurance because of a pre-existing condition. Birth control is now covered under insurance for women. 20 million people now have health insurance who were not able to get it before. There is also evidence to suggest that health care premiums have risen slower under Obamacare then they would have otherwise. These are all objectively good things -and it is worth remembering that- but Obamacare is not perfect.

In the Eye of the CL13 Beholder
In August 2008, 82% of Americans were dissatisfied with their health insurance and were looking for an overhaul of the system. yet, in 2016 people who overwhelmingly wanted Obamacare gone voted for Trump. In fact, 74% of Republicans want the Affordable Care Act repealed, but why?… Here is where it gets more complicated than memorizing all your Level 16 Wizard Spells. The numbers and benefits of Obamacare get a little murky when you start to look at them through the eyes of the average American. It is legitimately debatable if the ACA has benefited or hurt middle of the road Americans.

About 12.7 million people are now buying health insurance through State marketplaces or Healthcare.gov. More than half of all Americans still get their insurance through work. About a third of Americans are on Medicare or Medicaid. The rest are still uninsured. Overall, only about 4% of Americans are on the Obamacare exchanges, and in the past year their Obamacare premiums rose 22%. Yet, subsidies also rose, meaning that most people getting health insurance through the ACA will not have to shoulder the full cost of that hike in 2017. Unfortunately, those subsidies come from somewhere, and that is the taxpayer. Now there are indications that those healthcare premiums are lower than they would have been without Obamacare, but that has been disputed by conservative analyzers.

This whole debacle shows the weaknesses of Obamacare, like the soft underbelly of a mountain troll. Taxes have increased thanks to the ACA, but mostly for higher wage earners and the healthcare industry. Those along with the new mandates that force health insurance to cover sick people -we know its an odd thing- do mean that some costs have filtered down to middle-income and lower-income consumers and business owners. The paperwork has also become more complicated, especially in regards to the Individual Mandate, filing for exemptions, and filling out tax forms. More to the point, because of mandatory insurance laws for businesses some employers have cut workers’ hours so as to avoid giving them health insurance. For those people who are getting bare-minimum health insurance through their employers, they do not qualify for the marketplace, even though they could get better coverage there. Similarly, there is a not-so-insignificant population of Americans who do not qualify for healthcare subsidies, but who are still forced to purchase healthcare on the exchange at the higher price… And yes, under Obamacare, some people had to give up their doctors.

Rolling a Perception Check
So, in the end what does this all amount to? Every year America shells out a Dragon’s hoard of money to the insurance industry and Obamacare has not changed that very much. Even President Obama has admitted that. The law is not perfect and in need of fixing. The ACA has failed to insure all Americans, as only about one-third of eligible Americans are actually enrolled. It has failed to reduce healthcare premiums in any significant way or curb outrageous pharmaceutical and medical costs. Lastly, taxpayers -mostly high-wage-earners- subsidizes about $6,000 per formerly uninsured person. However, we ask that you don’t label it as a failed system just yet.

Part of the flaws of Obamacare came because it was a compromise law between Republicans and Democrats. It was not a single-health payer system, but it was also not an entirely free-market solution. It was a potion of lesser health, which only restores about 1d8+1 hit points. Strengthening certain aspects of the law can make it more effective in combating high costs and premium increases. It can also go farther to offer protections for low and middle-income households. Unfortunately, that all requires rational thought and debate, which is something so rare as to almost be Legendary in the US Congress these days. Donald Trump, our Orc-War-Chief-Elect and his clan of Republicans have made a career of calling for the appeal of Obamacare, no “ifs” “ands,” or “buts.” This “baby with the bath-water” solution fails to recognize the good of Obamacare. Instead of tearing it down we should all be working to improve it going forward, because it is not an entirely failed system.

You see, if there is one real benefit from Obamacare, it is that the law has changed our conversation. It is no longer about: “whether every American deserves healthcare,” but instead is about: “how do we make sure every American can have healthcare.” Women, pre-existing conditions, young adults, and low-income earners now all have a rhetorical and agreed upon right to be insured in our national conversation. We just need to figure out a better way to improve on what already exists, keeping the positive mandates while doing away with the bad ones. The Affordable Care Act is not the end goal that Democrats hoped it would be, but at least it was a step in the right direction. So maybe we should all calm down, ignore the propaganda of both sides; and think of the ACA as the first level on a long road to something better… Maybe even a Prestige Class.

*Disclaimer: A lot of this has been a simplification of our health insurance policies, and we apologize if we have made it too simplistic, as health insurance is a radically dense and labyrinthine subject matter. It is filled with pits, dungeon bosses, and a fair share of traps… which Todd refuses to disarm. Nat died because of you, Todd. He died.