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.
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.