Obamacare Hits a Bump

Paul Krugman in Obamacare Hits a Bump does a nice job explaining the current issues the program is facing, most notably about Aetna dropping out of many of the exchanges.

The story so far: Since Obamacare took full effect in January 2014, two things have happened. First, the percentage of Americans who are uninsured has dropped sharply. Second, the growth of health costs has slowed sharply, so that the law is costing both consumers and taxpayers less than expected.

Meanwhile, the bad things that were supposed to happen didn’t. Health reform didn’t cause the budget deficit to soar; it didn’t kill private-sector jobs, which have actually grown more rapidly since Obamacare went into effect than at any time since the 1990s. Evidence also is growing that the law has meant a significant improvement in both health and financial security for millions, probably tens of millions, of Americans.

Much of the new system is doing pretty well — not just the Medicaid expansion, but also private insurer-based exchanges in big states that are trying to make the law work, California in particular. The bad news mainly hits states that have small populations and/or have governments hostile to reform, where the exit of insurers may leave markets without adequate competition. That’s not the whole country, but it would be a significant setback.

But it would be quite easy to fix the system. It seems clear that subsidies for purchasing insurance, and in some cases for insurers themselves, should be somewhat bigger — an affordable proposition given that the program so far has come in under budget, and easily justified now that we know just how badly many of our fellow citizens needed coverage. There should also be a reinforced effort to ensure that healthy Americans buy insurance, as the law requires, rather than them waiting until they get sick. Such measures would go a long way toward getting things back on track.

But of course Congress is broken and Republicans are hostile to any fixes to Obamacare.