When Donald Trump and Hillary Clinton were asked by an audience member during Sunday's about the status of the Affordable Care Act, they both voiced similar concerns.
Trump was characteristically blunt, saying, "Obamacare is a disaster ... We all know it. It's going up at numbers nobody's ever seen worldwide. Nobody's ever seen number's like this for healthcare."
“Enrollment growth on the ACA exchanges has fallen far short of projections because uninsured middle-income Americans have largely decided that — despite the availability of subsidies and the penalty for not purchasing insurance — the insurance on offer is too expensive.”
Clinton voiced agreement about the costs, noting that "premiums have gotten too high," adding "copays, deductibles, prescription drug costs" to the list as well. She also noted an aspirational goal of universal insurance coverage, saying, "I want to get to 100 percent [coverage], but get costs down and keep quality up."
While that might sound nice, voters would be justified in wondering whether the ACA is up for the job. After years of falling short of enrollment goals and posting higher-than-expected costs, is the ACA still worth saving?
Weak Enrollment Growth
The ACA has stimulated dramatic changes to America's individual health-insurance market. It has placed more restrictions on insurance pricing (i.e., charging individuals different premiums depending on their health and age), and it has mandated benefit increases for insurance plans. Such changes have caused premiums on the ACA exchanges to soar by 49 percent, on average; younger, healthier adults have seen their insurance costs rise the most.
To encourage enrollment on the ACA exchanges despite surging premiums, the ACA deploys carrots — premium and cost-sharing subsidies — and a stick: Taxing individuals who remain uninsured. In 2015, for example, the average monthly premium subsidy for ACA-exchange enrollees was $263 per month, which reduced monthly premiums by 72 percent, on average — from $364 to $101.
In 2014, after accounting for attrition after the end of the first open-enrollment period, 6.7 million individuals had enrolled by Dec. 31. In 2015, 2.6 million additional individuals enrolled (and remained on their plans), raising the total to 9.3 million people enrolled on Dec. 31.
In 2016, overall ACA-exchange enrollment has remained lower than expected, and the gap between actual and forecasted enrollment is likely to widen further. In 2014, the ACA exchanges' first year, the 6.7 million enrollees exceeded the Congressional Budget Office's forecast of 6 million. But in 2015, total enrollment (9.3 million) lagged behind the CBO's March 2015 forecast (11 million). And if attrition trends remain consistent, total enrollment in 2016 (about 10 million) will be dramatically less than the CBO's March 2015 forecast (21 million).
Toward Universal Coverage?
Are these lower-than-anticipated ACA-exchange enrollment figures the result of uninsured individuals securing coverage by other means — such as by enrolling in employer-sponsored coverage or Medicaid? As the Department of Health and Human Services has noted, in a growing economy, employer-sponsored coverage typically rises as more people acquire jobs. Instead, from the fourth quarter of 2013 to the fourth quarter of 2015, employer-sponsored coverage in the U.S. declined.
Or take Medicaid. Enrollment in this government-insurance program for the poor expanded during the aforementioned period. But such expansion largely matched the CBO forecast — and, therefore, was also incorporated into the CBO forecast for ACA-exchange enrollment. Indeed, if the ACA exchanges' meager enrollment numbers were caused by a rise in coverage obtained elsewhere, America's overall uninsured rate would have declined in 2015. Instead, it barely budged, hovering around 11.9 percent.
In reality, enrollment growth on the ACA exchanges has fallen far short of projections...
Read the entire piece here at the Washington Examiner
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Yevgeniy Feyman is an adjunct fellow at the Manhattan Institute and a senior research assistant at the Department of Health Policy and Management at the Harvard School of Public Health. Previously, he was MI's deputy director of health policy. Follow him on Twitter here.
This piece originally appeared in Washington Examiner