The Future Of Obamacare

Local Providers Take Up The Slack
Some advisors, however, aren't particularly concerned about the decreasing number of exchange-listed providers for their clients who use the exchanges. "The companies that pulled out are national providers, and they only withdrew because they couldn't compete with local providers, which are doing well," observes Ellis Liddell, president and CEO of ELE Wealth Management, in Southfield, Mich. "The nationals can't operate profitably against the local providers. It was purely a business decision, not a sign that the exchanges are going to fall apart."

(Note: Aetna has been accused of withdrawing from the exchanges in an attempt to influence government regulators to accept its bid to merge with Humana, but the allegations remain unsettled.)

Liddell is optimistic about President Obama's signature accomplishment. "I'm basically telling my clients that the state of health-care benefits is fine," he says.

He argues that most health-care providers are prospering under Obamacare. "They're making more money now, not less," he says. Yet he also acknowledges that there are some problems in the current system. "Eventually the government is going to figure out how to do it right, how to get this to where there's best practices for everyone," says Liddell.

The Public Option
Liddell is in the camp that argues for the introduction of a "public option" -- basically, optional nationalized health insurance through an expansion of Medicare. It was discussed in the early days of Obamacare negotiations, then abandoned. "They dropped the ball, and that's how we got into this dilemma," says Liddell.

He hopes that in the coming administrations -- it may take several -- the federal government will reconsider lowering the Medicare age from the current 65. This could be done in increments, dropping the threshold by five years, say, every few years. The infrastructure is in place, Liddell holds, so such an expansion should be feasible and would help ensure fair coverage for all. "The public option might look different when it's finally put in place, but it will eventually show up," he asserts.  "The government will figure out how to include more Americans."

Others have suggested that a bigger federal investment in outreach to increase enrollment would buoy the system and possibly make plans more affordable. Liddell isn't buying it.  "Unless you've been living under a rock, you know about Obamacare," he says, laughing.  "The word is out."

Employers As Catalyst
But Liddell does hold with the idea of more government investment in "getting it right," he says, adding that that will probably only happen when more employers push for change.  "Now that the exemption for big businesses is over, we're going to start to see some changes," he predicts.

One big change: Although employers don't use the same insurance exchanges as consumers, they have just recently been allowed to access a similar government-subsidized discount marketplace -- the Small Business Health Options Program, or SHOP. Participating employers receive tax credits commensurate with the size of their businesses. In 2015 the Obamacare SHOP opened for employers with fewer than 50 full-time employees. In 2016 it became available for businesses with 100 or fewer full-timers.  

"As a small employer myself, health care is one of my biggest costs," says Liddell. "Once businesses start signing up their employees to save money, Obamacare is going to look phenomenal."

Next Steps
To some, of course, it already does. More Americans are insured than ever before. Still, whatever your view of Obamacare, at least one thing is clear: Our current health benefits system could be improved.

McClanahan wouldn't disagree, but to her, talk of repealing the A.C.A. misses the point.  Obamacare, she points out, means more than the insurance marketplaces. "Scrapping it would be a mistake, because there are so many good aspects of it," she says, citing the expansion in vital health-care delivery for many who would otherwise be left out.  "Obamacare provided something we needed in this country -- guaranteed issue coverage, which means you can't get turned down even if you already need medical attention.  That was a great first step."

The next step to fix Obamacare, she says, would be to simplify the range of coverage systems, which in turn "would rein in costs."