Well, how would we define that? The number of uninsured is way down, there’s no evidence of skyrocketing rates (leaving aside the patently broken methodology of hacks like Roy Avik), and even the ad campaigns of the republicans have shied away from criticizing it. It’s a pretty convincing success, IMO.
I’d still go with ‘too early to tell’. Not all of it has been implemented yet, and the full effects are still being sorted out. So, we don’t actually know if rates will skyrocket and I’ve seen no evidence that the ‘number of uninsured is way down’, though honestly I haven’t followed it’s progress that much and that might have been based on the early impression that not a lot of folks were signing up for it. Anecdotally, I don’t know of may people either family or cow-orkers who have signed up for it, even in cases where I would assume it would be to their advantage, but perhaps my personal sample size is small.
Two of the most crucial aspects have not been determined yet.
Rates on the exchanges are still in flux. In particular, what allowed a lot of carriers to offer competitive rates was the use of “narrow networks”. This was not apparent to a lot of people who signed up for such plans, but there’s beginning to be some pushback on those networks, and this could drive up rates significantly. (One thing that’s encouraging for the exchanges is that one of the major national carriers - I forget which - recently announced a major expansion of their exchange participation.)
The impact on employer plans is far from clear. Ironically, the more successful the exchanges are, the more likely it is that employers will ultimately cease offering coverage.
Well yeah. A lot of employers would love to avoid paying for their employees’ health insurance (& not just for financial reasons either - a lot of employers don’t like having to deal with it) and a lot are not going to give the $7,500 to their employees either. And even if they do, the employees are going to lose the tax deductibility.
There are 2 drivers of this. 1) is that since employees have an option on the exchanges, dropping coverage won’t put employers in as much of a competitive advantage as it previously did. So if a few employers drop coverage, that could turn into a flood pretty quickly. 2) won’t hit until 2018 and beyond, when the 40% excise tax on “high cost” plans hits. At some point virtually all employer plans are likely to be hit by this tax, and while employers will probably cope at first by cutting the benefits, at some point they’ll be bumping up against the minimum 60% actuarial value mandate, at which point they may as well drop their plans altogether. (It’s likely that the first thing to go will be Flexible Spending Accounts, which are likely to vanish shortly after 2018.)
Whatever the break-even number might be, it seems to me that paying for a group plan is more cost-effective than giving employees the cash and having them fend for themselves. It costs you the same, and they get a better deal on insurance. How is that not a good thing?
Good answers, plus it depends on how you measure success. The uninsured rate is down. That’s a big success. But it’s also fallen well short of the promises to used to sell it, which is why the public may not have warmed to it yet.
But in fairness, it was being “sold” on the basis of the proposals that were on the table at the time. Not everything came to pass as envisioned – the most important omission in my view was the public option, which could have done so much to control costs and improve accessibility. Which is why the insurance industry lobbied strenuously against it, and if AHIP doesn’t like something, well then by golly it doesn’t happen.
We have always paid 100% of our employees health care, including entire families. I believe it is the “right” thing to do, given that we live in time where employer-based health insurance is the primary way people get health insurance. I just think it would be nice to separate health insurance form employment, like “medicare for all” or some such thing.
Because the exchanges are an even larger group plan. It’s a wash if you’re a large enough employer, but for small employers (and “small” here can range into the hundreds of employees), rates on the exchange plans are better than you’re going to get for a business group plan for the same coverage (considerably better, in my state), for the same reason that larger group plans cost less money per individual.
There was no proposal that would have allowed everyone who liked their insurance to keep it. In fact, people losing insurance that wasn’t community rated and getting them into a new, more diverse pool, was essential for the plan to work.
The cost decreases also didn’t come to pass and I can’t imagine that the House bill would have been any better in that regard. There was just too much more Congress wanted covered to bring costs down. At best, maybe a public option might have helped make costs increase slower. We’re getting a 9% increase this year, maybe it would have been 5% with a public option. But there is no scenario where insurance companies have to cover a lot more and costs go down. A public option can eliminate the need to make that 3% profit margin, but it’s not going to make more generous insurance cheaper than less generous insurance.
It hasn’t done much as far as I can tell to reduce medical costs or slow the rate of medical inflation. But it has lowered the rate of the uninsured. Also various parts were good. Ending recissions, covering pre-existing conditions, covering kids up to 26, ending lifetime and annual caps, ending the medicare donut hole, etc. All big accomplishments.
Nonetheless, mandating people buy into a broken, overpriced system is a mild success. Fixing a broken, inhuman, overpriced system is a genuine success. I don’t see that happening on the federal level anytime soon.
As far as rates skyrocketing, it was my understanding most of the consumer protections didn’t add much to the total cost. Ending lifetime caps, annual caps, recissions, etc. and covering kids added a few percent to the cost of health care. Seeing how insurance rates jump 15-40% a year anyway I don’t know what effect if any the law has on increasing the cost of medical care.
Sadly, cost increases that were happening anyway are now being blamed on Obamacare. You have to factor those out and just find the ones that are truly due to Obamacare, then you have to determine if they are worth it. Personally I"m willing to pay 1-3% more to end recissions, lifetime caps, annual caps, and provide coverage for people under 26 as well as pre-existing condition coverage.
It’s not the insurance company practices that add to the cost, it’s increasing what they have to cover. Used to be you could by a more a la carte plan, or a company could look at their work force and decide that there are certain things that they aren’t likely to need. Maybe they forego mental health care, for example. An insurance plan that didn’t have to have mental health care is going to be cheaper than one that does have to have it.