Basic Assessment and the ACA
It is going to be possible to find people whose premiums are going up, just as it is going to be possible to find examples of people who are now overjoyed that they can get insurance. This is a good time to remind ourselves that the plural of anecdote is not data.
First, in terms of assessing the law, we all have to remember that the vast majority of Americans will not be directly effected because they already have health insurance through their employers.
Second, this means that the focus has to be on how the law impacts the previously uninsured and also the way it affects persons who get their insurance individually (e.g, the self-employed, small business owners, etc.).
One of the ways that we are going to have to assess the law’s impacts is going to be linked to the exchanges and the degree to which they do, or do not, provide cheaper insurance to those who use the service (and yes, the degree to which the technical side of the process actually functions is also important).
In looking into this situation, however, we have to remember a few things:
1. Individual insurance rates have been steadily going up before the ACA passed. Therefore, the degree to which current rate increases are ACA related are questionable. Some clearly are (for example), but others are part of a clear long-term trend. Also, that private insurance companies are more than happy to blame the law for price increases should not be a shock. They currently have a great excuse for the changes, and obviously they are going to take it.
2. The focus on private insurance is just, as I have noted on many occasions, the deepening of the pre-ACA system. There is no public option unless one is poor or over 65. The disparity between what an individual had to pay for family coverage if one had a good job versus what a self-employed person pays is not a new phenomenon.
3. The true place to focus in evaluating the policy is on the exchanges, which are supposed to create more market pressure (in a limited form) on the system by allowing insurers to directly compete for the business of those who do no have employer-based insurance. Part of the problem currently is that in many states there aren’t that many options. As the piece linked above noted, Blue Cross/Blue Shield controls 88% of Alabama’s health insurance market.
4. The fact that many Republican-controlled states refused to set up their own exchanges is, therefore, really more ideological cutting off one’s nose to spite one’s face than it is a sound policy decision (especially since the exchanges have the most market-linked elements of the entire policy package).
5. Some areas for long-term testing of the law’s efficacy include:
a. How many people sign up for insurance who previous had none.
b. How many people opt to pay the tax penalty.
c. How many people were able to get a cheaper rates once they shopped the exchanges?
d. Will the inclusion of many more young, healthy persons on the rolls of private insurance push price down?
e. Will the lack of strictures against pre-existing conditions force prices up?
f. If prices continue to rise (which is likely), is the slope of the trend higher, lower, or roughly the same in comparison to the pre-ACA trend?
g. There is also the issue of the way in which premiums, taxes, etc. go up to pay for things like the expansion of Medicare.
In the short term, technical problems with the website (which are real) nor uplifting stories about the newly insured (which are real) nor depressing tales of rate increases (which are real) can tell us much of anything about the general efficacy of the law.