Affordable Care Act Checkup

Posted: September 12, 2016 by Nazim in ACA


We’ve covered the cases that went to the Supreme Court, and it’s been a couple of years since it’s been implemented, so it’s time for a checkup on Obamacare. How is it doing?

Despite the initial hiccups with the website, the coverage marketplace or exchange seems to be working: we’ve seen large drops in both the number of uninsured and the uninsured as a proportion of population.  However, a lot of insurance rates have certainly gone up. The notion that “if you like your current plan, you can keep it” has proven to be false for a large number of people.  Health care insurance premium rates, have recently gone up dramatically, even though the average did not change much when the reform was initially implemented. It’s hard to compare this rate to that in a parallel universe in which Obamacare was not implemented. Historically, rates have gone up pretty steadily and at a rate higher than inflation, so, these rate increases might also happen in that parallel universe.

The Affordable Care Act (which is the official name for Obamacare) also smoothed a lot of regulatory wrinkles and closed a lot of coverage loopholes, such as exclusion of coverage for pre-existing  conditions or the Medicaid part D prescription drug “donut hole” coverage gap. However, annual wellness checkups are free, even though they don’t always end up that way.

Perhaps the biggest question is whether Obamacare has reduced the number of bankruptcies due to medical debt. Well, this is a complicated question to ask. Money is a fungible form of payment, which is to say that if I owe you and two other people $30 each, and I only have $50 to pay all my debts, none of the debts are individually unaffordable, but the combination of my debt is unaffordable in the aggregate. So, if one of those debts is to a medical provider, it’s disputable whether I can say that my ensuing bankruptcy was due to the medical debt. And this is the most common scenario. However, medical-related bankruptcies continue to be a problem, even though they have gone down significantly in Massachusetts, which implemented Romneycare in 2006, after which Obamacare was modeled. On the other hand, Massachusetts has a pretty comprehensive array healthcare safety nets, which the nation as a whole lacks, and the rate of underinsured (folks with lower overall coverage or higher deductibles) has been going up, probably due to increased premiums, which may explain why the rate of medical bankruptcies of insured has is far from dropping.

I’ve been trying to end this on a bright note, and I’m not sure I have a relevant one, so here’s a somewhat relevant one: overall, bankruptcy rates are decreasing in the US, but this trend is not imputable to Obamacare. On the other hand, Canadian bankruptcy rates have been steadily trending up, although they remain lower than ours. That makes me happy in a nya-na-nya-na-nyaaa-naa kind of way. Just kidding. I love our hat. And, regarding Obamacare, it’s a mixed bag, and it’s not going anywhere, so we’ll just have to wait and see.

  1. […] causes such controversy, and for good cause, it’s worth trying to untangle some of the issues presented by what I’m generically […]


  2. […] Foundation and then adopted by Republican then-governor Mitt Romney in Massachusetts. And while I’ve criticized the legislation before (let’s face it, it’s a gift to the private health care insurance industry to require […]


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