The defenders may continue to say it ‘works’ as a function of the program enabling coverage to some previously uninsured people. But its ability to do that was tied to the assumption that a large pool of healthy rate payers would enroll as a function of statute, and that these people would fund the system with its new mandates and expensive to insure enrollees.
Healthy rate payers for exchange policies have been elusive, and mainline, mass subscriber companies – like Aetna and UHC – have found the business impossible. You do have some boutique companies who seem to be making a profit after claims provided they can manage pools of high premium paying subscribers who do that because their income allows for generous Obamacare tax credits.
The anecdotal expertise I speak from around here is young under 50 middle age suburban strivers right….. I had my roof done this summer by a local contractor. So I encounter this guy, and I’m like I always am, do what I always do…. Give him the Studs Terkel / Working analysis. And knee jerk is ooh, contracting, what a great business to be into, look at the multiple well kept 2 ton trucks in the office parking lot, prolly makes loads of money, why didn’t I become a contractor…..The guy shows up at my house on tear off morning and he’s got a huge stitched gash on his forehead. Work boo-boo …. he tells me that at the ER the doc wanted to do an MRI and he declined cuz it seemed a clean cut, the MRI was in the low multiple thousands, and he doesn’t have insurance….
I was kind of floored. Guy is organized, guy is middle age, guy is not superficially ‘fast and loose’, and he was going w/out health insurance. Well, it’s explainable. He’s no doubt past the $89k subsidy cutoff and the premiums were too high, like $3k a month for him and his wife, for a policy that would / would not have have meaningfully insured him from ongoing medical expenses given his age and care consumption… And ya know, you can’t get blood from a stone. He may not have the money to write a $3k + check every month even if he’s grossing $150k a year.
That’s your anecdote, that’s ACA’s problem, the one that makes it ‘not work’. Healthy people with jobs but without group insurance aren’t buying in given the high premiums and deductibles, so there’s no mitigation of the actuarials of people who can buy in with subsidies. Actuarial death spiral, it’s no longer a potentiality, it happened.
So no, Obamacare doesn’t work such that it became ‘subsidized risk pools’, and too expensive for normal middle class people….that’s not what it was supposed to do.
I’m not a nihilist anymore right, so I don’t expect repeal, don’t desire it as a positive good. The coverage that was extended needs to stay, PPACA has to be fixed…needs to be fixed as a function of it NOT WORKING, alright.
Such that you got a Democrat POTUS and Senate coming up, ya know, the paranoid righty thing is to believe we get single payer shoved down our throats. No, that’s not going to happen. Now, something will happen, because with the expiration of risk corridors and the absence of funding authorizations, stuff crashes. It’s just employer insurance doesn’t go away at this point, its stronger as an institution with the Obama admin having fucked up the individual market. And I think HRC goes for a pragmatic, middle ground solution out of wisdom and the necessities of practical politics. IE, I don’t think the Democrats are going to want to give up those seats they just won in 2018.