The ACA–What’s Working and What’s Not
Despite some recent rhetoric, the Affordable Care Act is far from "exploding," using any reasonable definition of the word. Here is a quick rundown of where the Affordable Care Act stands right now, what's going well and what's not so great.
- The exchanges are stable. Supporters of the current health law received something of a boost last week with the Congressional Budget Office's initial assessment of the Republicans' bill. If the Affordable Care Act were kept in place, the CBO wrote, the exchanges wouldn't explode at all. “The nongroup market would probably be stable in most areas under either current law or the [Republican] legislation," the nonpartisan office wrote.
- Many people are shielded from premium hikes. Although premiums have climbed substantially in some states' exchanges, PolitiFact found this week that "most people purchasing health care through the marketplace didn't feel it." A study by the Kaiser Family Foundation shows that a 40-year-old who makes $30,000 could have paid the same $208 a month for an average marketplace health insurance policy in both 2016 and 2017, as long as they were willing to shop for the best price.
- The uninsured rate has fallen — a lot. Probably the biggest positive supporters of the Affordable Care Act point to is the fast-falling rate of people who don't have health insurance. Before the ACA, more than 16 percent of the population was uninsured. Then in 2013, the first year that the Obamacare marketplaces went live, the uninsured rate fell to 13.3 percent, and then to 10.5 percent in 2015, and to 8.9 percent in the first half of 2016, the lowest ever.
What's Not Working
- Few insurance options for many Americans. The Affordable Care Act does have its weaknesses. As more companies have pulled out of the exchanges, Americans are left with fewer choices in their coverage. In many parts of the country, as Trump and his fellow Republicans often point out, enrollees in the insurance exchanges have only one choice of insurer. An analysis by the Kaiser Family Foundation found that five states — Alabama, Alaska, Oklahoma, South Carolina and Wyoming — have only one insurance company selling policies on the Obamacare exchanges. And the share of the population that has three or more companies to choose from fell from 85 percent in 2016 to 57 percent this year.
- Big premium hikes for some Americans. While it's true that many Americans in the exchanges — 64 percent, according to PolitiFact — haven't seen their out-of-pocket spending on premiums rise, around one-third did. Those premium hikes were steep in some states, such as Arizona, which saw its average premiums more than double. And for those who were shielded from rising premiums by subsidies, the government picked up that much more of the bill.
- Higher deductibles making health care more expensive for many.
And premiums aren't the extent of health care spending. For most people, out-of-pocket costs such as deductibles and co-payments have also risen. The average deductible for workers getting individual insurance through their employers was $1,478 last year. That's up by 49 percent over five years. That helps counterbalance the slower growth in premiums.