For years, President Donald Trump has repeatedly said the Affordable Care Act is on the verge of collapse. As he puts it last week, the health care law is “exploding.”
Is Obamacare really about to fall apart? The short answer is no -- there are areas of the country where the ACA’s markets are working well. In others, though, it’s struggling. Meanwhile, the Trump administration holds many of the levers that will determine whether the Affordable Care Act lives or dies.
Obamacare, as the ACA is often called, has helped 20 million people get insurance, mainly by expanding the Medicaid health program for the poor and by creating markets for individual insurance where many can buy plans. Medicaid is relatively immune to collapse, since it’s funded almost entirely by state and federal governments, though some lawmakers would like to limit its spending.
When people say Obamacare is disintegrating, they’re usually referring to its individual markets. Premiums have shot up on the exchanges, and choice has declined for many. Sign-ups for exchange plans this year, at 12.2 million, were down modestly from 2016.
Attractive Subsidies
For consumers, one of the most attractive features of the ACA’s plans is that government subsidies help offset cost increases, and about half of those who buy individual plans are eligible. However, people who make too much to get subsidies -- about $48,000 for an individual -- have to pay full freight. A 50-year-old, for instance, would spend an average of $574 a month for a mid-level silver plan this year, according to data compiled by HealthPocket. That’s 17 percent more than in 2016, and the policy would have a deductible of about $3,500.
Plan choice is also a growing problem. While the Congressional Budget Office said the ACA’s markets are “stable in most areas,” about 42 percent of those buying coverage on Obamacare’s exchanges had just one or two insurers to pick from for this year, according to the Kaiser Family Foundation. There are parts of Tennessee where there may not be any exchange insurance options for 2018. And Oklahoma’s insurance regulator warned last week that his state’s lone carrier may quit the market.
“This isn’t one market, this is really 51 markets,” said Chris Jacobs, a health policy analyst who runs Juniper Research Group. “That’s something that defies simple slogans.”
Tennessee’s Troubles
While insurer choices wane, premiums rise: Across the country, premiums for so-called benchmark plans climbed 25 percent for this year. In Arizona, the benchmark premium jumped 116 percent, a fact often recited by Trump as a sign of the ACA’s failure. In Indiana, on the other hand, where Vice President Mike Pence was governor, premiums declined 3 percent.