Tuesday, February 05, 2019

ACA Was A Failure

No, really, a total failure. Yes there were some good regulatory changes. Yes the exchanges make it possible for some people to buy on the individual market (though that insurance is mostly...not good). Yes the Medicaid expansion was great.

But the important thing to remember about the Medicaid expansion was that it was a last minute *fix* to keep the price tag down. Think about that. It was cheaper to provide free health care for more people than to throw them onto the subsidized exchanges at subsidy levels that they could possibly afford. If they'd taken it up to 500% of FPL and 600% of FPL it would have been even cheaper! And that became a political problem, because your poor neighbor has free health care and you have to pay for a bronze plan which sucks.

The failure was the exchanges. Now we're supposed to talk about all of the other good things in ACA, but remember back in 2009, the exchanges *were* Obamacare. They were the plan. Everything else was tinkering. The exchanges were going to free us from employer-provided health care (a good goal!) by letting everybody buy "affordable" individual health insurance. The exchanges were going to be great, because there's nothing we love more than buying health insurance every year through a website, and employer-linked health insurance would, over time, just fade away. ACA wasn't about the exchanges because a few million more people would be able to buy insurance. ACA was about the exchanges because the exchanges were THE FUTURE OF HEALTH INSURANCE, my friends.

Nobody involved wants you to remember this. And the same people are going to bullshit you in 2020 and beyond.