Editorial: ACA Not Dead Yet

Saturday, January 06, 2018

The year-end holidays overshadowed some rather remarkable news: Despite all the Republican efforts to drive a stake through the heart of Obamacare, nearly as many people signed up for health insurance under the Affordable Care Act during the 2017 open enrollment period as did the previous year. If, as President Trump asserts, the program is “imploding,” he should hope his presidency implodes in similar fashion instead of the manner that appears far more likely.

The numbers tell quite a different story from the one concocted by the president: 8.8 million people signed up during the 2017 open enrollment period, which ran from Nov. 1 to Dec. 15. That compares with the prior year’s 9.2 million, when the enrollment period was twice as long and was widely advertised. More than a quarter of 2017 enrollees were new customers, while 6.4 million returned to HealthCare.gov to pick a plan or were re-enrolled automatically.

Even these figures do not fully reflect participation, because they tally only those who signed up in states that use the federal HealthCare.gov marketplace. Eleven states, including Vermont, maintain their own insurance exchanges, which also have been reporting strong enrollment. In several big states, they remain open until later this month. Moreover, many more millions of Americans have gained coverage under the Medicaid expansion provisions of the ACA, which 32 states have adopted. In New Hampshire alone, 43,000 people have gained coverage in that way.

Ironically, the GOP’s reckless and feckless efforts to repeal and replace the ACA appear to have had the opposite effect: Rather than undermining support for the law, they raised public awareness of it and motivated consumers to sign up, according to polls cited by The New York Times.

Republicans might want to take a look at where the largest numbers of people who enrolled to get coverage in 2018 live. The leading states were, in order, Florida, Texas, North Carolina and Georgia. Politics aside, consumers in red states also recognize the importance of health care coverage and appreciate the premium subsidies they receive to help buy it. (More than 80 percent of those purchasing coverage through HealthCare.gov qualify for federal subsidies. The average monthly subsidy for 2018 will be $555, a 45 percent increase from 2017.)

Undeterred, the Republicans at year-end rammed through Congress a tax cut bill that repealed the ACA’s “individual mandate,” which imposed a tax penalty on those who did not buy insurance. The idea behind the mandate was to induce people who were younger, healthier and less expensive to cover to buy health insurance, thereby shoring up the market for everyone. And, again ironically, it was a conservative idea, conceived in the 1980s by experts at The Heritage Foundation who deemed it a good way to encourage personal responsibility. That is, it was also designed to end freeloading by people who didn’t carry insurance and whose health care costs ended up being paid for through higher premiums borne by people who did. But when the individual mandate became a central provision of Obamacare, it suddenly became reviled by conservatives who once embraced it.

Trump has claimed that the tax cut law “essentially” repeals Obamacare by ending the individual mandate. It doesn’t. Essential provisions remain, including requirements that insurers cannot deny people coverage or charge higher premiums because of pre-existing conditions. People who receive subsidies still get them, and they rise along with premiums. Medicaid expansion is a success story that a number of Republican governors, along with their Democratic counterparts, deem vital.

But the Congressional Budget Office predicts that with the end of the individual mandate, as many as 13 million more Americans could become uninsured in 10 years’ time, and that premiums will go up by an additional 10 percent a year. It remains a puzzle why Republicans in Congress appear hell-bent on driving up costs, driving people out of the health insurance market and creating uncertainty in one of the nation’s largest economic sectors. Thank goodness that more and more, Obamacare looks as though it is gaining the widespread acceptance it needs to become a permanent part of the social safety net.