Here we are again. The Trump presidency is redoubling its efforts to repeal the ACA, the courts are once again assessing the legislation’s legality and a presidential election is quickly approaching where healthcare will be a central issue. So, what better time to review the current state of enrollment in the “Obamacare” state and federal exchanges and consider the implications full-throttle repeal would have on the insurance markets?
As a quick reminder, there are about 330 million Americans, of which approximately half gain coverage through employer-sponsored plans. Medicare covers another nearly 60 million while Medicaid covers over 70 million Americans. After considering those enrolling in the veteran’s health plan, there remains roughly 40 million Americans who need to purchase individual coverage or will remain uninsured. Well the 2019 open enrollment has concluded, and the grand total participation is 11.4 million; lower than the 11.7 million in 2018, 12.2 million in 2017 and the 12.7 million peak in 2016. And in fact, Gallup recently released a survey indicating that the uninsured rate in the country has increased to 13.7%, meaningfully above the low of 10.9% achieved in 2016 but well beneath the peak of 18% in 2013.
Clearly the Trump administration’s posture towards the exchanges is a major factor – significant funding cuts toward the promotion of the exchanges plus the elimination of cost-sharing subsidies have made a dent in the exchange enrollment, as has some of the Republican efforts in the Obama years to limit subsidies to the health insurers who were bleeding money in the early years of the insurance marketplaces.
But what is also plainly obvious to anyone in this country purchasing healthcare – either through their employer or individually – is that ACA has achieved no meaningful paradigm shift in cost containment of healthcare or accessibility. So it’s no wonder Democrats are now coalescing behind the economic fantasy of “Medicare for All” or that Republicans are once again repeating their tired refrain of “repeal and replace.” The affordability and accessibility solution to the 3.5 trillion dollar question continues to remain elusive.