There is proof positive that the Affordable Care Act is alive and functioning. All Republican reports of the act’s demise are, as Mark Twain glibly wrote about erroneous reports of his own death in 1897, “an exaggeration.”  

Look no further than D.C. Health Link, the government exchange providing healthcare insurance, through the ACA, to Washington D.C. Since opening in 2013, the D.C. exchange has managed to avoid expensive cost increases, loss of providers, and limited plan choices plaguing some other exchanges, causing those others to become whipping-boys for opponents of the act. Health Link offers choices from four insurance companies and over 100 different plans to small business owners alone.

The exchange is popular with individual insureds. There are few who have any inclination to make changes. The most popular features are those at the core of Obamacare: coverage of preexisting conditions; children may remain on the policy until age 26, enough time for a solid career start; no lifetime insurance company payment limits; insureds cannot be kicked off a policy for getting sick; and free preventative screenings are examples. These are all coverages unregulated companies have refused to cover, or charged higher fees in the past.

An individual policy, the Blue-Choice HMO Silver has a premium of $229 a month ($2,748/yr.), which is only $93.50/mo. more than Medicare premiums. The yearly deductible is $1,300 and emergency room copays are $300. It is not a junk policy and covers every mandate of the ACA. Individuals or families could choose lower deductibles and E.R. copays for an increased premium–it’s their choice.

There certainly are exchanges across the country that are struggling to provide policy choices and getting companies to offer plans. Many are more expensive and have had increased premium costs–although most increase percentages are less than the yearly averages from years before the ACA. 

The reason for the problems isn’t a function of the act, it’s a function of neglect. By the time the exchanges became active the Democrats lost control of Congress and federal ACA budgets were slashed. After Donald Trump took office in 2017 he even went as far as to cancel pre-paid advertisements to inform those in need of insurance about open enrollment dates. The most beautiful and prolific rosebush will die if it isn’t watered.

D.C. Health Link flourishes because it is loved and nurtured. The exchange has an 11-member board–seven voting members and four public officials. One public official is from the D.C. Dept. of Health, one from Human Services, one from the Dept. of insurance, and one from Securities and Banking. They all have professional expertise and authority to coordinate and manage exchange issues that need development or revision.

This exchange offers both in-person and internet advice and instruction for individuals and families. They provide advice and offer policies to small business owners who want to provide for their employees, and tools for insurance brokers. They don’t sit and wait. They advertise by getting out into the community. Health Link booths are common sights at conventions, rallies, and public celebrations. They have sponsors that support and encourage enrollment including the Chamber of Commerce, the Greater Washington Hispanic Chamber, the National Association of Health Underwriters, and the Restaurant Association. That’s a lotta love and support that other exchanges do not get.

Want another reason for the success of the D.C. exchange? It is the exchange through which every Senator, every Representative, and all of their staffs buy their own healthcare insurance. Congress has a vested interest in seeing that the exchange works. There is a public misconception that Congress gets free insurance. They don’t. They pay about one-third of their premiums with the other two-thirds being paid as an employment benefit by the public. They buy through the exchange because, in a move during debate, Sen. Chuck Grassley (R-Iowa), trying make the whole act unacceptable, inserted an amendment calling for Congress to get insurance through the exchanges. He thought the Democratic members would balk, thinking the exchange much too plebian, vote that idea down, and scuttle the whole act. At the very least, Grassley thought he could make hypocritical hay out of Democrats voting against his amendment then for the bill. It backfired. The Democrats liked the amendment, included it, and made it a part of the act that became law. Ergo, the D.C. exchange is the most nurtured exchange in the country. 

The Affordable Care Act needs work. It was born as a compromise and an experiment. Today, revisions are needed that were unforeseen in 2010. A public option for variety in policies, offed in concert with Medicare or Medicaid, would offer competition that would reign in cost increases. Also, offering a compromise to those who champion Medicare for all. The purchase mandate supported by tax penalties, which was original in the act, needs to be revised so those who do not want to buy insurance are convinced to do so. We’ve gotten general acceptance about buying auto insurance while universal health insurance is a tougher sell. Government subsidies need monitoring for effectiveness as well.

Given the care D.C. Health Link gets, every exchange could be as high functioning and effective. We need to convince our elected representatives to support the law and work to improve it within its framework that, contrary to Republican rhetoric, does work. Obamacare is a healthcare winner!

Terry Donnelly is a retired teacher. He taught in public schools in Kentucky, Michigan, and Colorado. He was an adjunct faculty member instructing teachers and teacher trainees at Michigan State University, University of Colorado, and Adams State College in Colorado.