Problem is, Obamacare isn’t exploding. Most importantly, healthcare inflation remains relatively low.
Very misleading; you’re implicitly stating that health care inflation is an independent variable. It’s not. It is dependent on core inflation, and historically runs at 1.75x to 2x core inflation. Your own graph shows this, and if you run a regression on those datapoints, you find an extremely high correlation, in the general neighborhood of R = 80, IIRC.
So, as long as we remain in a slow economy (as illustrated by the Fed’s reticence to raise the funds rate) health care inflation will remain low. But when the economy normalizes, we’re right back to where we were before the ACA.
A systemic explosion, something big enough to break down partisan politics, would see the right side of that graph spiking, like the mid-1970s.
True, but you won’t have that sort of systemic explosion without something being totally out of wack — — like inflation was in the late 70’s. Back when people were buying homes and feeling lucky if they locked down a 15% interest rate. These are not good memories for those of us who were adults then.
The Medicaid expansion — which accounts for a little over half the 23 million gaining insurance under the ACA — is working well enough that Republican governors in states that implemented it, most prominently Ohio’s John Kasich, argue against its repeal.
True, but the Trustees continue to warn us that benefits will take a substantial hit in the near future, as the system continues to pay out more than it takes in from the payroll tax. The unfunded liability of Medicaid was about $10T before the expansion. One shudders to think what it is today.
However, this brought prices in line with the Congressional Budget Office’s original predictions. Every previous year, premiums remained below expectations as insurers competed for new customers. 22% increases every year would be disastrous, but most non-partisan analysts believe it’s a one-time correction.
Hmmmmmm…..I think recent estimates are predicting another pretty painful increase for 2018. Although it is admittedly early.
Anthem likely to retreat from Obamacare for 2018, analysts say
Insurer Anthem is likely to pull back from Obamacare's individual insurance markets in a big way for next year…
And even if premiums jump again, ACA subsidies rise as costs increase. That would strain the federal budget, but not impose much burden on customers, limiting the political reaction.
The political reaction is what it is. But the people who actually pay those premiums unsubsidized are the self-employed, which annoying to some, is the primary engine of job growth in the US. If they’re paying more in health insurance, they’re not expanding their businesses to the extent they are able.
So, the ACA SYSTEM might not come under political pressure for the reasons you say, but it should be remembered that if the ACA continues to experience massive cost overruns that have to be picked up by the taxpayer…..that should sound familiar to anyone who was breathing in 2008. Plus, it’s like strapping a 2-ton weight to the back of our small business owners and expecting them to succeed while dragging it through the mud.
The biggest problem is insurers exiting exchanges in rural areas because they were losing money. 32% of counties have only one insurer participating. Alabama, Alaska, Oklahoma, South Carolina, and Wyoming have only one in the entire state. As a result, 21% of Obamacare participants, almost 2 million people, do not have a choice of insurance company, eliminating any claim that the ACA creates market competition in those locations.
Right. And this will get worse when Anthem exits. A lot worse.
At the national level, separate studies by the CBO and the Brookings Institute both concluded Obamacare is not in a “death spiral,” noting that sign-ups for 2017 are similar to previous years, with a similar risk pool.
Depends how you define “death spiral”. Liberal commentators are defining it differently than conservative commentators. To wit:
To be fiscally viable, the ACA needed 40% of its insured to be “invincibles”, basically defined as healthy individuals between 27 and 35/40 who would overpay for their policies in order to fund the older and less healthy, who are getting a lot more health care than they’re paying for due to the 3:1 ratio limitation. (For those who don’t know, the ACA doesn’t permit any premium to be more than 3X the cost of the lowest premium charged in the system.)
Hence, premiums continue to rise at a fast rate for all participants as the insurers struggle to make a buck.
The ACA never got to 40% invincibles; it’s stuck on 26%. So, liberals and the government say “not a death spiral” because they are defining “death spiral” very specifically as a constant and consistent decrease in invincible participation.
So, to a conservative, a “death spiral” is any one of a number of imbalances factors that will continue to compound until the system collapses in some way.
The problem is the 3:1 ratio. It’s too beneficial to the older and sicker, and it drives up the premiums for the invincibles. Hence, you get 26% instead of 40%. It’s just too expensive for the value it delivers, if you’re young and healthy.
The AHCA tried to fix this problem, moving to a 5:1 ratio, but everyone went batshit crazy because it would increase premiums on the older and sicker. True, that. But the system is doomed to a cycle of increasing premiums, sucking more and more taxpayer money in subsidies, as long as the 3:1 ratio exists.
Ask the businesspeople, the ones who actually can lose their jobs if they make bad business decisions, agree: (Nobody loses their job, btw, at the CBO or Brookings if they are wrong, it should be said.)
Aetna chief executive says Obamacare is in a 'death spiral'
Aetna chief executive Mark Bertolini said Wednesday that the Affordable Care Act's exchanges - the marketplaces where…
So, true, the number of invincibles is not decreasing, it is stable. But, the fact that it stablized at 60% of its target is creating other imbalances which are death-spiralling.
I think your matrix has great value in simplifying the GOP views on this, btw. I personally am sick of the bickering and would love to see a decent solution in any of those quadrants other than the lower left. Anything that comes out of that quadrant is going to be nasty.