In a normal year, this presidential election would be turning in large part on the steady collapse of Obamacare. It's the signature achievement of a fellow Democrat, and yet Hillary Clinton would be caught between trying not to alienate Barack Obama's loyalists and acknowledging the only "fix" for the law at this point is pretty much to start over. If, that is, she had an opponent putting any kind of consistent, considered pressure on her about the law.
The problem will still exist after the election, though, so let's look at it on its own merits. Here are some of the lowlights :
- The average premium for a benchmark "silver" plan on the Obamacare exchanges will rise by 22 percent next year -- 25 percent on the federal exchange. That's three times faster than the rate increase this year.
- Many consumers will bear the brunt of these price increases themselves. For others, the increases will be masked by subsidies. That doesn't mean the increases are fiction; it means the people for whom the "Affordable" Care Act is actually unaffordable shifts from consumers to taxpayers.
- We can expect things to get worse from here, not better, because competition is shrinking. The number of carriers participating in the exchanges will fall by about one-quarter, to 228 from 298. About 1 in 5 consumers will be offered a plan by only one carrier, including everyone in five states. It's little better in Georgia , where 1 in 6 will have just one carrier and 1 in 3 will have only one or two.
- As premiums rise and competition shrinks, choices of health providers are narrowing, too. One of the main ways insurers have kept price increases to "just" 22 percent has been reducing the number of providers they'll work with. So not only was "if you like your plan, you can keep your plan" a lie , so was "if you like your doctor, you can keep your doctor."
- The other big part of Obamacare, the expansion of Medicaid, is also costing more money because people aren't behaving as expected. While Medicaid is often pitched as a way to keep people from visiting the ER for non-emergency care, it hasn't worked that way. Instead, ER visits have gone up , a big reason the Medicaid expansion is costing 49 percent more than projected just a year ago.
One reason Obamacare isn't working as promised is that, as we've discussed previously, millions of younger and relatively healthier Americans are still choosing not to purchase insurance. What's the response from liberals? The following seems to be representative:
The mandate tax (er, penalty) isn't working, because either premiums are higher than expected or government planners are poor judges of how rational individuals will act (or both). But let's indulge the tax-slash-penalty-must-be-larger line of thought. The point of the mandate tax/penalty is to encourage people to buy insurance, right? If so, blaming the tax/penalty for being too small necessarily implies it is perfectly fine to expect people making less than $24,000 a year (roughly 200 percent of the federal poverty level for a single person) to spend more than 6 percent of their income on a health insurance plan. And not even a good health insurance plan: That amount is for a plan that likely comes with such a large deductible it gives them no benefit unless they're badly injured in a car wreck.
Likewise, this logic implies something about the tax/penalty people should pay if they won't buy such a plan. Namely, that it would be just fine to raise these people's taxes -- which they would owe if they don't buy insurance -- by a larger percentage (6.4 percent) than Hillary Clinton proposes for "the rich " (a 4 percent surcharge on those making at least $5 million per year).
Once you start down this path, it never ends. The only conclusion we can take from Obamacare is that a private market regulated extremely heavily won't act like a real market. The left will tell us that's a reason to make health insurance a public good. That's like saying the antidote to poison is more poison.