To the right’s dismay, scare tactics —remember death panels? — and spuriouslegal challenges failed to protect the nationfrom the scourge of guaranteed healthcoverage. Still, Obamacare’s opponentsinsisted that it would implode in a “deathspiral” of low enrollment and rising costs.
But the law’s first two years of fullimplementation went remarkably well. Thenumber of uninsured Americans droppedsharply, roughly in line with projections,while costs came in well below expectations.
Opponent s of r efor m could havereconsidered their position — but that hardlyever happens in modern politics. Instead,they doubled down on their forecasts ofdoom, and hyped every hint of bad news.
I mention all of this to give you someperspective on recent developments thatmark a break in the string of positivesurprises. Yes, Obamacare has hit a fewrough patches lately. But they’re much lesssignificant than a lot of the reporting, letalone the right-wing reaction, would haveyou believe. Health reform is still a hugesuccess story.
Obamacare seeks to cover the uninsuredthrough two channels. Lower-incomeAmericans are covered via a federallyfundedexpansion of Medicaid, which wassupposed to be nationwide but has beenrejected in many Republican-controlledstates. Everyone else has access to policiessold by private insurers who cannotdiscriminate based on medical history;these policies are supposed to be madeaffordable by subsidies that depend on yourincome.
Nobody ever expected Obamacareto cover all the uninsured. I n fact,Congressional Budget Office projectionsmade in 2013 suggested that about 10percent of nonelderly U.S. residents wouldremain uncovered: some because they areundocumented immigrants, some becauseof the gap created by red-state Medicaidrejection and some because they would fallthrough the cracks of a complicated system.
But the law was nonetheless projected toproduce a sharp reduction in the number ofAmericans without insurance, and it has,especially in states like California that havetried to make it work.
Meanwhile, both insurance premiumsand the cost of subsidies designed tomake them affordable came in far belowexpectations in both 2014 and 2015.
Sooner or later, of course, there werebound to be some negative surprises. Andwe’re now, finally, getting a bit of bad, or atleast not-great, news about health reform.
First, premiums are going up for next year,because insurers are finding that their riskpool is somewhat sicker and hence moreexpensive than they expected. There’s a lotof variation across states, but the averageincrease will be around 11 percent. That’s aslight disappointment, but it’s not shocking,given both the good news of the previoustwo years and the long-term tendency ofinsurance premiums to rise 5-10 percent ayear.
Second, some Americans who boughtlow-cost insurance plans have beenunpleasantly surprised by high deductibles.
This is a real issue, but it shouldn’t beexaggerated. All allowed plans coverpreventive services without a deductible,and many plans cover other health servicesas well. Furthermore, additional financialaid is available to lower-income families tohelp cover such gaps. Some people may notknow about these mitigating factors — that’sthe problem with a fairly complex system —but awareness should improve over time.
Finally, UnitedHealth Group made asplash by announcing that it is losing moneyon the policies it sells on the Obamacareexchanges, and is considering withdrawingfrom the market after next year. Therewere some puzzling things about theannouncement, leading to speculationabout ulterior motives, but the main thingto realize is that UnitedHealth, while a hugeprovider of employment-based insurance, isactually a fairly small player in this market,and that other players are sounding muchmore positive.
Oh, and official projections now say thatfewer people will enroll in those exchangesthan previously predicted. But the mainreason is that surprisingly few employersare dropping coverage; overall projectionsfor the number of uninsured Americans stilllook pretty good.
So where does that leave us? Withoutquestion, the run of unexpectedly goodnews for Obamacare has come to an end,as all such runs must. And look, we’retalking about a brand-new system in whicheveryone is still learning how to function.
There were bound to be some bobbles alongthe way.
But are we looking at the beginnings of adeath spiral? Some people are indeed sayingthat, but as far as I can tell, they’re all peoplewho have been predicting disaster everystep of the way, and will still be predictingimminent collapse a decade from now.
The reality is that Obamacare is animperfect system, but it’s workable — andit’s working.
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