Wednesday, November 16, 2016

Back To Wonking

When the admittedly exaggerated news about ACA exchange individual coverage premium hikes came out, the initial wonky response was that the exchanges are just a tiny part of the Obamacare system so no big woop. This piece on the popular/unpopular parts of Obamacare ignores the truly popular - at least for those who can get it - part of Obamacare, which is the Medicaid expansion.

Yes the exchanges/private insurance system as enshrined need this complicated mix of regulation/subsidies/mandates/penalties to work. There would be no bad bits if the subsidies were generous enough, putting everyone on Republican Medicaid, or if you just put everyone on actual Medicaid. No one would care about the mandate if it was actually affordable for everyone. It does put insurance in reach of people for whom it wasn't in reach before, but the bad bits aren't there because they're necessary, they're there because they're necessary as a part of this incredibly stupid and complicated and wasteful system. Fine, best we could do, but let's be clear about that.