Health Care’s Growing Pains

The United States is in the middle of the third open enrollment period since the restructuring of the national health insurance market under the Affordable Care Act. Some of the news so far is hopeful. The percentage of the population that is uninsured has been reduced to below 12 percent, more than 5.5 points down from the rate before the A.C.A. mandate went into effect in 2014.

On the other hand, insurers in many states are raising premiums and increasing deductibles. A number of plans are seeing increases north of 20 percent; in a much smaller number of states, premiums have actually decreased. With the rate of enrollment growth leveling off, insurers are discovering that their risk pools are less healthy and thus more costly than originally projected. Some of the higher costs will be offset by increases in the tax credit insurance subsidies provided by the A.C.A., but many people will still need to shift plans to find something affordable. While it is too soon to declare this the beginning of the dreaded A.C.A. “death spiral,” in which the cost of plans, even after subsidies, is high enough to discourage enrollment by the healthy (which would drive the costs higher still), it is certainly reason to be concerned. One of the needs it highlights is for better data and more thorough analysis of the situation in order to identify and learn from places where the program is functioning more smoothly.

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The A.C.A. has significantly improved the availability of health insurance, but it clearly needs to be adjusted in the light of experience. An imperfect law ought to be the starting point for reasonable political argument toward practical reforms. The difficulty in doing so should not discourage us from working on health care but rather encourage us to ask more from our legislators.

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Joseph J Dunn
3 years ago
The Editors are right, there will be a need to make adjustments in the ACA, at the minimum to prevent the 'death spiral' of ever-higher premiums discouraging more healthy people from buying the mandated coverage. But to move forward, we will have to put aside some widely held misconceptions. The first is that health insurers' profits are a main driver of rapidly escalating premiums, and a non-profit insurance model, perhaps co-ops, would solve the problem. The failure of half of the ACA-inspired "co-ops," and the filing for higher rates by the surviving co-ops, should disprove that popular myth. http://www.wsj.com/articles/obamacares-cascading-co-op-failures-1446509803. One other myth (or maybe it's two myths, closely related) is that drug company profits are "out of control" and need to be reined in by regulation, using mechanisms already written into the ACA, http://www.wsj.com/articles/the-coming-government-takeover-of-drug-pricing-1448231481. or more heavily taxed. Either of those approaches will produce adverse consequences, as recent tax-inspired moves should make clear. http://www.wsj.com/articles/pfizer-and-allergan-to-merge-in-huge-inversion-deal-1448280652. Let's hope for a bi-partisan discussion, and may it address the root causes of our health-care challenges.
Tom Fields
3 years ago
Ask more from legislators??? ACA is not working. 1. Ask the working people whose costs have gone up while medical care---for them selves and their children have gone don REMEMBER---health insurance is NOT health care! There is no evidence that ACA has made anybody healthier--or that it has instilled good habits, check-ups, better care of children, use of services, etc. The "problem" was 30 million uninsured. That could have been solved by giving them low cost coverage and education. Instead--we are ruining our system while the politicians collect kick backs--AND--keep their old--Cadillac plans. When will America wake up!
Tom Fields
3 years ago
Ask more from legislators??? ACA is not working. 1. Ask the working people whose costs have gone up while medical care---for them selves and their children have gone don REMEMBER---health insurance is NOT health care! There is no evidence that ACA has made anybody healthier--or that it has instilled good habits, check-ups, better care of children, use of services, etc. The "problem" was 30 million uninsured. That could have been solved by giving them low cost coverage and education. Instead--we are ruining our system while the politicians collect kick backs--AND--keep their old--Cadillac plans. When will America wake up!

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