Thread by @wendellpotter

10 years ago today, on the 1st anniversary of the Affordable Care Act, I wrote about the good things the law did, but stressed that we needed to view it as only the *starting* point of a journey toward needed reform.

Unfortunately, we have not made much progress on that journey.

Although ~20 million now have health insurance as a result of the law, a huge growing percent can’t use that insurance to get the care they need. That’s because Congress & the Obama admin were too focused on premiums... exactly what the insurance industry wanted them to focus on!

Focusing on premiums meant that Dems gave scant attention to how insurers would pick Americans’ pockets by jacking up *deductibles* year after year. In fact, deductibles are patients’ biggest struggle now, more than having enough doctors in-network, or even the price of premiums.

Zeke Emanuel, who advised Obama on health policy, recently told @nytimes that not addressing deductibles was “a huge mistake.” While Congress just passed a $1.9 trillion Covid relief bill, Emanuel said they were under pressure in 2010 to keep the price of ACA under $1 trillion.

While the ACA provided premium subsidies to Americans earning up to 400% of the poverty line, subsidies for deductibles stop at 250%. 4 of every 10 enrolled in an Obamacare plan are underinsured thanks to deductibles. And almost 1/3 employer-sponsored coverage are underinsured.

People in high-deductible plans don't go to the doctor when they should, or pick up their Rx because of the thousands they pay out of pocket before insurance kicks in. Meanwhile, insurance companies posted record profits every year since the ACA was passed, even during COVID!

As growing numbers of Americans skip needed care, those insurers are paying their top execs, like David Cordani, the CEO of Cigna, where I used to work, astronomical salaries. The company noted in a filing last week Cordani’s pay totaled $79 million!

Cigna execs were saying back when I was there that Americans needed to “put more skin in the game.” Obama & Congress bought that line. It’s way past time that *Cigna* put skin in the game. And that government give people relief so they can actually use their insurance, for once.

The Kaiser Family Foundation says that the year before the ACA was passed, most people on average were able to meet their deductibles by March 18. That was what KFF refers to as Deductible Relief Day. Last year Deductible Relief Day didn’t arrive until May 19.

The bottom line is this is a broken system. The ACA did a bunch of good things. But our work to fix this mess is not close to over.
Not by a long shot.