The ACA has performed pretty much as effectively as expected, after a rough start as people held out for repeal, exchange websites didn't function, and implementation was delayed. the CBO thought the uninsured 2016 rate would be 11%, it was 10%. Obama set a bar far lower than that, many say intentionally undercutting the numbers to ensure "success." But the official government target was dang near spot on.
The
CBO estimates that under the Trump plan there will be 26 million
additional Americans without health insurance in 10 years . That is double the number we expect under the current law and it is predicted to be more uninsured people than the United States has ever seen (since we kept track of such a thing).
Exactly the opposite of Trump's promise to make sure everyone has coverage. We are currently
near a record low for number of people without health insurance (11.3%, up from 10.9% when Trump took office). It was nearly 18% when the ACA took affect (
nearly 50 million people.)
Under previous trends we expect the rate to drop and the total number of people to remain fairly flat. Under the new plan, we expect to see more people without insurance going forward than we ever have before.
And of course that is ignoring that of the approximately 26,000,000 adults who are not insured,
5.2 Million would be insured if eligible states expanded Medicaid. That would reduce the rate to ~7-8% of the population without health insurance and further reduce the number moving forward. The current rate is about exactly where the
CBO thought ObamaCare would get us, if additional states expanded Medicaid the program would have greatly exceeded expectations.
In short - ACA was as effective in reducing the uninsured rate as expected. The new plan ends up with more uninsured than ever before (and frankly about where we would have been without the ACA). All to supposedly "save money."
But the new healthcare law saves us $119 Billion over ten years. When coupled with the other Trump provisions we would likely see a deficit increase over current projections of
$4,000,000,000,000.00 in ten years ($4 Trillion, unless the cuts and increased military spending cause the economy to double or triple its growth rate [which no economist will say] - then it is "only" a $2 Trillion deficit increase over current projections). Pretending this is something to save the government money doesn't fly.
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I'm not pointing this out for some "everyone deserves health insurance yay peace and love" reason. But we have been paying double the money for worse results than most industrialized countries for decades. At the same time the number of people cut off from all but emergency healthcare has ballooned, leading to even more inefficiencies (so many ER docs have to waste time playing primary care doc or treating conditions that should have been headed off months earlier, then we whine about ER wait times and ER docs not spending enough time with us. Let alone the general inefficiency of treating stage 4 crisis over prevention or catching it early). Not only does this bankrupt families, it ends up costing ME additional money because I pay for healthcare, which is jacked up to help pay for people's healthcare who bankrupted out of their bills. Of course it is worse when you factor in those who would otherwise be willing or able to work, but can't because of a health issue so are now on disability.
And that's not mentioning the pressure on private sector (and public) employers trying to compete with overseas companies who have a built in efficiency in healthcare. 18% of all GDP in this country is spent on healthcare. That's nearly double the GDP expenditure than the average OECD country and nearly 6 full points above the #2 nation by GDP (Denmark). That means US companies have to pay a huge amount of employee healthcare and/or pay more to employees. On average Americans (and/or the government or their employer healthcare) is paying $5,000 each more, per year, for healthcare than the average person in an advanced economy.
The system has grown inefficient and less than optimally effective. It has been straying further and further away from "fixing" itself. I'm not arguing the ACA is a solution, but something has to change. Going back to the way it was as the system grew dysfunctional isn't likely to fix it either, it leaves twice the number of people without insurance, and doesn't really save money.
And that's not mentioning the pressure on private sector (and public) employers trying to compete with overseas companies who have a built in efficiency in healthcare. 18% of all GDP in this country is spent on healthcare. That's nearly double the GDP expenditure than the average OECD country and nearly 6 full points above the #2 nation by GDP (Denmark). That means US companies have to pay a huge amount of employee healthcare and/or pay more to employees. On average Americans (and/or the government or their employer healthcare) is paying $5,000 each more, per year, for healthcare than the average person in an advanced economy.
Okay, that’s a sobering fact right there: 18% of GDP is spent on healthcare. Sheesh.
While we are all patting CBO on the back for its estimates (this comes from an article in fact check saying CBO was pretty spot-on in its projections). However, there’s a pretty good gap in estimates on those buying insurance through exchanges (over-estimated by about 12.5 million) and they underestimated people joining the Medicare rolls by over 4 million. They still missed the participation mark by 9 million or so.
I’m just pointing out that this estimate of 26 million losing coverage by 2026 is still somewhat of a shot in the dark.
In my opinion, Obamacare
could have left the health insurance industry alone and relaxed the regs on who qualifies for Medicaid. They could have simply raised payroll taxes and provided a government-funded system for those who wanted it or could not qualify on private health insurance. For that matter, why is Medicaid a federally-funded program administered by states in the first place? To my knowledge Medicare is funded by and administered by the Feds (please correct me if I’m wrong since I’m not of that age yet).
Anecdotally, there are younger people in our cycling peer group I know of who are electing to pay the penalty rather than buy insurance. I always assumed one goal of Obamacare was to get people who simply would not prioritize insurance as a financial responsibility to buy it. Guess what? Those who didn’t prioritize it before still don’t. From the time I was 20 on, I always had at least a major medical policy. I can understand someone who is very healthy and is practicing proactive healthcare doesn’t plan on a lot of doctor visits during the year but I do believe a policy for catastrophic illness or injury is just a no-brainer. You figure out a way to pay for it, but that’s just me.
Health insurance has been one issue which has been in the back of my mind since before we moved to New Mexico. I’m fortunate I was given the opportunity to stay on with the company I worked for in Tulsa so it’s not a worry at this time. However, if they decide to sell off or decide they’d rather have someone sitting in my old desk every day, MC and I will be forced to find insurance. Hearing bits and pieces that Trump’s plan would sock it to those over 50 definitely gives me pause.
Exchanges
Where CBO had trouble was predicting the number of newly insured who would get their coverage by purchasing private insurance through the new exchanges set up by the law. CBO predicted that in 2016 there would be 23 million getting policies through the exchanges. The actual number was 10.4 million during the first half of the year, according to the Centers for Medicare & Medicaid Services.
That’s less than half the predicted total.
Medicaid
On the other hand, CBO was too low in its estimate of the number who would gain coverage through expansion of Medicaid, the state-federal program for low-income people and children.
CBO estimated 10 million would be added to the Medicaid rolls by 2016, even with many states refusing to expand eligibility. But that was too low. As of the first quarter of last year, 14.4 million adults had enrolled in Medicaid as a result of the Affordable Care Act’s expansion of the program, according to an analysis by the nonpartisan Kaiser Commission on Medicaid and the Uninsured.
So to a large extent, CBO’s mistake was in estimating where the uninsured would get covered, not how many of them would gain coverage.
Enrollment for this year on the exchanges doesn’t seem to have quite met expectations either.
http://money.cnn.com/2016/12/21/news/economy/obamacare-enrollment-record/
