After the 2016 election of Donald Trump, who campaigned with a promise to “repeal and replace” the Affordable Care Act (ACA, or “Obamacare”), what will actually happen? While I don’t pretend to have a crystal ball, we can make some educated guesses about the upcoming year.
Obamacare Has Failed
The ACA has failed on almost every promise. Its effects have made a mockery of its name. Average insurance premium increases of 24% are set for 2017 alone, not to mention prior price increases, with four states seeing average premium increase of more than 50%. The ACA has reduced the medical options of virtually all Americans via progressively narrower insurance panels—a move the insurance companies have made to maintain fiscal viability.
Insurance plans forced upon those with subsidies come with ever-increasing deductibles that reduce access to healthcare. Obamacare supporters claim as their success 20 million newly insured Americans. However, even with financial support for their insurance premiums, most cannot afford healthcare, because they can’t afford their average $6,000 Bronze plan deductible. While they can claim to have insurance, they still are prevented from accessing medical care.
Unfortunately, Obamacare has moved into a “death spiral.” The insurance premiums will continue to increase while insurance coverage continues to decrease due to adverse selection. Healthy patients must pay into this system in order to maintain the fiscal solvency of the insurance companies. If the pool of the sickest patients keeps growing, while the pool of healthy patients keeps shrinking, the insurance companies must pull out of the market or go bankrupt. This is what we have been seeing in the insurance market: progressively fewer options for insurance, at progressively higher prices, for progressively fewer healthcare options. Don’t expect this to change for 2018, which will see an ever-tighter turn in the death spiral. At this point, even most Democrats recognize this as an untenable situation.
Republicans have never backed the ACA, as witnessed by its passage in a Democrat-controlled House and Senate without a single GOP vote. Now, six years later, with Democratic politicians losing control of the House, Senate, and Presidency, Democrats are calling for changes as well.
Most notably, Sen. Elizabeth Warren (D-Mass.) stated in a recent article, “Americans want reform to Obamacare— Democrats included. We must bring down the costs of health insurance and the cost of health care.” And she’s not the only one. Many traditionally Democratic voters abandoned their party’s presidential candidate over the rise in healthcare costs attributable to the ACA, as noted by a Muslim immigrant who voted for Trump, writing in a Washington Post article, “I am a single mother who can’t afford health insurance under Obamacare” (Washington Post, November 10, 2016).