Costs loom as next big hurdle
Despite a healthy appetite for newlaw, challenges remain.
washington » Seven million people signed up, so there is an appetite for President Barack Obama’s health care law, but that doesn’t guarantee success for the country’s newest social program.
Big challenges are lurking for the next enrollment season, which starts Nov. 15. Chief among them are keeping premiums and other consumer costs in check, and overhauling an enrollment process that turned out to be an ordeal.
“They have demonstrated the law can work, but we are a ways off from being able to judge its success,” said Larry Levitt, an expert on health insurance markets at the nonpartisan Kaiser Family Foundation.
Republican opponents of the law keep pushing for a repeal, but as millions of people obtain insurance, how long can the party’s strategy remain a politically viable option?
“What the Republicans need to really pay attention to is what they would do different from the Affordable Care Act,” said economist GailWilensky, who ran Medicare under President George H.W. Bush.
“Just talking about repeal is not going to make it with 7 million people getting insurance on the exchange. … We are beyond that.”
The source of the pent-up demand that propelled health care sign-ups beyond expectations could stem from the nation’s new economic reality: a shrinking middle class and many working people treading water in low-paying jobs.
Health insurance has been one of the pillars of middle-class security for decades. With fewer jobs that provide health benefits, there was an opening for a government program to subsidize private insurance.
It could take the rest of the year to sort out how many uninsured people have actually gotten coverage, the ultimate test of Obama’s law.
Early statistics provided by the administration have not been useful, mingling uninsured people with those who previously had coverage. Still, vindication for Obama’s law isn’t guaranteed.
Health insurance premiums tend to go up every year, so the question nowis how much higher in 2015.
“How fast they go up will no doubt vary across the country,” Levitt said. “Public judgment of the law will be influenced by howrapidly premiums rise.”
There’s a back-and-forth going on, he said. An improving economy and the law’s taxes on insurers will tend to push up premiums. Mechanisms in the law to assist insurers with a disproportionately large share of high-cost patients will push down premiums.
The big unknown is what economic bets insurers made when they jumped into the markets created by the law. If theywere conservative and figured a big share of costly cases among the newly insured, that would take some pressure off premiums for next year.
The advocacy group Families USA, which has supported the law from its inception, says the government should nudge insurers to covermore routine medical care outside of the annual plan deductible, the amount consumers pay before insurance kicks in.