Obamacare’s Secret Success

The Democratic campaign has crackled with energy around “Medicare for All,” with one candidate after another jumping into the argument about how best to bring health care to all Americans.

Lost in all the back-and-forth is that much of this revolution has already happened. Under the Affordable Care Act, several states have already achieved near-universal coverage, and without anywhere near the national disruption that a full system reboot would cause. As of 2018, six states and Washington, D.C. have achieved over 95 percent health care coverage for their residents.

Click to expand...

But the trend is not uniform across the country. Some Republican-controlled states have especially high uninsured rates. Texas has an uninsured rate of 17.7 percent, with a fifth of the nation’s uninsured children. Georgia’s uninsured rate is 13.7 percent, and Florida’s is 13 percent. Together, just these three states account for roughly a third of all uninsured Americans.

Countering these failing states are Hawaii, Iowa, Massachusetts, Minnesota, Rhode Island, Vermont and D.C., which, using the tools provided in the ACA, have all achieved coverage rates over 95 percent and as high as 98 percent.

Click to expand...

swing_voter said:

A lot of small business people depend on Obamacare now. They don't have an employer who'll subsidize their health insurance like us employee types.

Small business owners make up a lot of the republican base.

So I'm saying that improved Obamacare isn't so far fetched.

Click to expand...

Greenbeard said:

Periodic reminder that universal coverage is within reach. As Zeke et al point out in Politico today, the most straightforward tools for getting there are already in use in some combination in those states that have gotten closest to achieving universal coverage: Medicaid expansion to poor single adults, reinsurance to back some of the highest cost insurance claims out of commercial premiums, policies to promote enrollment (e.g., funding navigators), more generous premium and/or cost-sharing support for marketplace plans, standard benefit designs, and perhaps reinstating an individual mandate.

Obamacare’s Secret Success

Click to expand...

Greenbeard said:

Periodic reminder that universal coverage is within reach. As Zeke et al point out in Politico today, the most straightforward tools for getting there are already in use in some combination in those states that have gotten closest to achieving universal coverage: Medicaid expansion to poor single adults, reinsurance to back some of the highest cost insurance claims out of commercial premiums, policies to promote enrollment (e.g., funding navigators), more generous premium and/or cost-sharing support for marketplace plans, standard benefit designs, and perhaps reinstating an individual mandate.

Obamacare’s Secret Success

Click to expand...

Neomalthusian said:

I think what is frustrating for me to see during an election year is that almost no one really knows, cares, or wants to know or care about actual policy. The candidates seem to feel a need to run on firebrand rhetoric that continues attacking the entire private insurance sector, reject compromises or policy improvements, and so forth. Pragmatists have to vote with a hunch or a hope that the candidate will turn moderate and make compromises once in office.

I'm in business with my wife (no other employees) and next year we could conceivably make about 200% of our basic household expenditure need (we don't spend frivolously). With that discretionary income, we would like to be able to just pay off our house. But if we do that, our mAGI will be high enough that it will cause our cost of insurance premiums to increase by a factor of 10. To avoid this, we have to maximize our Solo-401k contributions instead of paying off our house faster. And at some point we can't avoid it at all. That's the subsidy cliff. It just needs to go away. But too few people really care about this or have any reason to care about this.

Click to expand...

Greenbeard said:

The good news is that candidates running on building on what's already in place and beefing up the ACA (e.g., Biden, Buttigieg, Bloomberg) all address the low-hanging fruit of fixing the family glitch, removing the income cap on tax credit availability, re-scaling the affordability thresholds, etc. That's also the position the House Dems have taken in their ACA 2.0 legislation. And indeed building on and improving the ACA is popular among Dem voters, as well, though you probably wouldn't guess that from the media coverage or the primary debate stages.

This stuff is the Democratic consensus on what needs to happen next at this point. They just need to find a way around the nihilism of the GOP.

Click to expand...