J. Clarence
Jul 25, 2017 · 2 min read

The Affordable Care Act did not and has not failed. Moreover, in the areas where the law is not meeting expectations we know why that is the case and how to address, as the law was written and intended to be enacted; namely enforcing the mandate and expanding Medicaid. We know this is largely the case as the states that have elected to establish their own exchanges and to expand Medicaid are doing much better under the program.

Premiums have gone up much faster than the law intended, but that is driven by the fact that the IRS, under direction of both the Obama and Trump administration, is not enforcing the tax penalty, which leaves insurance pools disproportionately sicker than the general population, which prompts insurers to raise premiums to help cover the cost. The Republican plan, or plans, on the floor now also have an in effect individual mandate via either threatening to lock people out of the market altogether or forcing them to pay a 30% increase for a year, the effect of which is the same as the mandate, the law is directing people to “buy insurance, or else”. So the primary gripe about taking away “freedom” is, when you look at it under a microscope, a lie.

Beyond that the changes made to Medicaid, which Republicans claim will put the program back on sustainability, only does so by design in ultimately reducing the services provided, because it block grants and gives states a set amount. Which is fine, if that is the political decision Republicans want to make, while they propose tax cuts for the wealthy; however, it is disingenuous to claim that what is being proposed somehow is about maintaining the same level of care and service.

The law does need to be reformed, to account for the Supreme Court decisions and the fact that the states will not as readily expand Medicaid; however, nothing in the Republican plans so far would accomplish the actual problems in the law. It might lower the annual rate of premium increases for healthy people by getting rid of many essential health benefits and pre-existing condition protections required now in all plans, but only through marginalizing sick people into high risk pools, which the bills under fund.

    J. Clarence

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    Amateur Wonk. Free-Market Progressive. DC resident. Policy and politics lover. Doughnut aficionado.