I agree with this observation from Jonathan Bernstein, from his most recent column in the Washington Post:
If the law works — if the website is repaired, if people sign up through the exchanges in sufficient numbers, if competition on the exchanges really does bring costs down without undermining the kind of care consumers want, if Medicaid expansion goes smoothly where Republican opposition allows — then there’s no chance that it’s going to be repealed, or delayed.
but I’m not so sure about this:
If it really does collapse, then it’s certain that it will be delayed or even replaced, although again that would mean building on what’s been done.
I suppose it depends on what the operative definition of “collapse” is. I strongly suspect that regardless of what happens supporters of the PPACA will be proclaiming its success while its opponents will be declaring its failure. Once again, they each have their own facts.
Mr. Bernstein has some signficant omissions in his list of “ifs”. The anecdotal reports suggest that most of those who’ve signed through Healthcare.gov are enrolling in Medicaid and that some of those qualified under the old eligibility rules. The states will not receive 100% reimbursement for them as they will for those who qualify under the new eligibility rules. If a very large proportion of those enrolling for Medicaid via Healthcare.gov would have been eligible for Medicaid anyway, I’d say the system will have collapsed then and there. The states are already unable to keep up with their share of Medicaid and thousands or millions of new participants will already aggravate a bad situation. Providers are already waiting many months for reimbursement under Medicaid in some states, notably Illinois. And that 100% reimbursement will be phased out after three years. That has been one of the things I’ve been most skeptical about in the plan. What happens after three years? Here in Illinois the cupboard is already bare.
I also wonder what proportion of those who actually enroll for insurance under the exchanges will be older people with pre-existing conditions as opposed to people who are young and healthy. If the young and healthy just don’t participate the entire plan will be ineffective from the outset but the shoe won’t really fall until next year when new and presumably higher premiums will be charged.
IMO we’re probably stuck with the PPACA as-is for the foreseeable future and as to what its impact will be we can only say “we’ll see”.
Health insurance is not simply a widget, like a lot of financial instruments, “trust” is a large part of the value that needs to be bought into. A “collapse” wouldn’t be resolved by a delay, it would require changes that would re-establish trust. No predictions here, but the role of “delay” should be to avoid “collapse,” not respond to it.
I think this anecdote is pretty interesting – it shows some of the “unexpected” features of the ACA as well some of the perverse incentives:
http://www.propublica.org/article/loyal-obama-supporters-canceled-by-obamacare
As someone who is (by insurance purposes) “young” and “healthy,” I feel lucky to have good health care options provided by my employer (including a high deductible plan where I get to stash away a substantial sum in a HSA for years in the future when I will not be young and may not be healthy).
If I did not have employer-provided coverage, I’d find it hard to justify any of the ACA plans financially. Don’t get me wrong, it’s a good thing to have health insurance and I’ve never been without it. But the penalty is too small to really justify the cost, IMO, for a lot of younger people who have decent but not high incomes (and say, lots of student loan debt, where the deduction is capped).
If I made my exact salary but my employer didn’t offer insurance, I think I’d rather take the penalty than bear the costs of a bronze plan. If we’re serious about the penalty, it should be at least as expensive as the coverage itself, if not more so.
I’m nost sure how ‘trust’ in the PPACA can be remedied. The very fact that Obama has misstated dozens of times that people could keep their policies is bad enough. Now the official correction of that statement, is only deepening his dishonesty, as more is revealed about the bargain the insurance companies made, early on, with the administration.
Apparently, the only way insurance companies could qualify for government subsidies was if they agreed to cancel all policies that didn’t meet the criteria of the PPACA. The bill was structured and then modified even more after it’s passage, to narrow down the possibilies and avenues people might have to retain their chosen HC insurance. This bill has shrunk HC networks as well, increasing the odds that doctors and hospitals will also change for people.
“I feel lucky to have good health care options provided by my employer ..
That may all change when the big business HC mandate kicks in a year from now. January ’15 is when the second, and more massive rounds of cancellations will likely take place, which is where that new number, of 129 million losing their coverage, is being derived.
jan, I doubt it. Partly because of the industry I work in, and partly because I think that the organization I work for knows that even now, they compete for employees, and health care is a decent benefit.
Don’t get me wrong; if we ended the tax loophole that made employer-sponsored healthcare dominant, I wouldn’t shed a tear.
The question, though, is if your prediction comes true, what happens to corporate profits? Health insurance has skyrocketed as a % of total costs per employee.