With 8 million Americans enrolled in health insurance through federal and state exchanges, President Obama has declared the Affordable Care Act a success. That’s disingenuous and big changes are needed to make the law work well.
Overall, the ACA’s goals were to provide reasonably priced medical care to the 45 to 50 million uninsured and slow health care cost increases. It is hardly clear those will be accomplished.
The rollout of the exchanges to market coverage to individuals was botched. Scarcely a surprise, Health and Human Services and state agencies could not replace the millions of private decisions facilitated by free markets with computer software.
When the websites failed, public focus shifted from measuring ACA performance against its original objectives. With those now functioning, the ACA should be evaluated against its original objectives.
Many of the 8 million enrolled to replace individual and small business policies, canceled thanks to ACA rules, or to obtain federal subsidies only available through the exchanges.
Expanded eligibility rules permit Medicaid to cover additional millions in the 25 states. In other states, legislatures have chosen not to participate; in part because of concern the federal government will not cover 90 percent of the cost long term.
It remains to be seen how many Americans will remain uninsured thanks to Washington’s lack of credibility in many state capitals, and the program’s inability to control costs enough to permit most employers to keep offering coverage.
The ACA requires health insurance policies to pay for a wider and more expensive scope of services than many individual and small business policies covered prior to the law.
In many counties, only a few insurers chose to offer policies on exchanges. Absent competition, insurers lacked incentives to bargain as hard as before with hospitals and other providers, further raising premiums and out of pocket costs.
The bronze, silver and gold policies offered by exchanges mostly vary in their deductibles. Folks selecting bronze and silver plans with high deductibles are now paying the full cost of doctor visits that only set them back a $20 or $30 dollar co-pay prior to the ACA.
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