Whither Obamacare now?
Don’t know if you’ve noticed, but the Affordable Care Act (aka Obamacare) seems to have hit an equilibrium point. It’s not clear where additional insured persons are going to come from.
You’ll recall the ACA’s goal was to “cover” most nearly everyone. There were 3 routes to new health insurance coverage First, Medicaid income eligibility requirements were loosened. Originally states were not required to buy into this, but the penalty for opting out was loss of all federal Medicaid funds. In the first Obamacare Supreme Court case (NFIB v. Sebelius) the court ruled that such a drastic penalty amounted to unconstitutional coercion. States were free to reject the expansion. So far, 31 states have declined. But there appears to be not much appetite among those refusnik states to ever opt in. That route isn’t going anywhere at the moment.
The second path was through the subsidized federal “exchanges” Even HHS Secretary Burwell has given up on grabbing many additional enrollees when the third enrollment period opens up on November 1. Her goal is now 10 million, down from 20 million just a few months ago. That’s about how many who currently sign up (and actually pay premiums). And this is in the face of a $600-odd penalty for being uninsured in 2016. Many view the expensive, high-deductible exchange policies as not worth the money, even with the federal subsidy. No growth on that front.
The third route to health insurance was the employer mandate. Employers with more than fifty people (swiftly relaxed to 100), with “employee” being defined as 30 or more hours per week, had to furnish health insurance. This was a nonstarter from the git-go. Almost as soon as the ink was dry on the ACA, it was recognized (including by many Democrats) that this created a powerful disincentive for full-time employment. Political pressures are all in the direction of relaxing this mandate further. No growth in the number of insured to be had here.
The bottom line is that the ACA has cut the original number of uninsured (variously estimated at 40-odd million) by roughly half–about 10 million from the exchanges and another 10 million from states choosing to expand Medicaid.. Here it has stalled, a long way from its stated goal That will become increasingly obvious in coming months.
What direction to take from this “equilibrium” point will be (well, at least it ought to be) a major topic for the presidential candidates. The Left will clamor for a full-cry single payer government system with a “See, we said we should have done that in the first place”. Those of us who are horrified at this prospect will argue for more market based alternatives.
One thing is clear. We need Yogi Berra. “When you come to a fork in the road, take it!”