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The Obamacare Reckoning: The Uninsured Were Already on the Rise Pre-COVID

October 27, 2020

October 27, 2020
By Naomi Lopez

Judge Amy Coney Barrett has been confirmed and sworn in to the U.S. Supreme Court. That means there is now a 6-3 conservative majority to rule on the latest legal challenge to the Affordable Care Act (ACA), commonly known as Obamacare, scheduled to take place immediately following the elections.

As a result, the levels of fear and enthusiasm, depending on one’s own political views, are reaching fever heights. But anyone who believes that the outcome of this case will solidify the future of U.S. healthcare is mistaken.

The ACA was passed in 2010 with the promises of providing near-universal healthcare coverage and dramatically lower premiums for that coverage. Unfortunately, neither goal has been met. And the sad reality is that, even if one has an insurance card, that does not necessarily equate with timely care, as many providers are no longer participating in the ACA provider networks, and many families are unable to meet the high plan deductibles which can exceed $8,000 before insurance benefits kick in.

A recent state-by-state study of ACA enrollment conducted by the Centers for Medicare and Medicare Services (CMS) found that those individuals and families who don’t receive a significant ACA subsidy are dropping coverage. Among the study’s key findings:

  • “From plan years 2016 to 2019, unsubsidized enrollment declined by 2.8 million people, representing a 45 percent drop nationally. At the state level, the percentage change in unsubsidized enrollment over this period ranged from a 4 percent drop in Rhode Island to a 90 percent drop in Iowa.”
  • “Looking at state-level enrollment trends between 2016 and 2019 also shows the link between enrollment and premium trends. States with larger declines in unsubsidized enrollment tended to experience a larger increase in average premiums.”
  • “Review of state-level data also shows that trends in declining enrollment began from 2015 to 2016 for 10 states. Declining enrollment occurred in 44 states from 2016 to 2017, 43 states from 2017 to 2018, and 39 states from 2018 to 2019.”

Increasingly, individuals and families are making the difficult decision between health insurance and other financial obligations and priorities. That is why it is important to note that last year, before the pandemic, the nation’s uninsured rate for the non-elderly was already approaching about 15 percent.

Fortunately, alternatives to both protect those with pre-existing conditions and better ensure that people can get the care that they need and when they need it are already being proposed. Take, for example, a plan by the Health Policy Consensus Group called Health Care Choices 2020: A Vision for the Future. The comprehensive plan developed by some of the nation’s leading free-market and conservative healthcare policy experts. The plan provides a robust safety net, restores the doctor-patient relationship, and returns more authority and flexibility to the states. According to a recent analysis of the plan, about 4 million more people would obtain healthcare coverage and access to more providers would also increase by the end of this decade. In addition, the plan is estimated to reduce ACA premiums by about one-quarter over this time period for silver plans for both individuals and families.

Regardless of the outcome of the current ACA legal challenge and the election, much work will remain in order to deliver on the unmet goals of healthcare access and affordability. That is why lawmakers in the states should continue to strive for meaningful healthcare reforms that put patients and their doctors in charge of important healthcare decisions.

Arizona is one state that is a national leader in healthcare reform. Reforms of recent years include, but are not limited to: corralling off Direct Primary Care from insurance regulators, allowing for renewable short-term limited duration health insurance, expanding the scope of practice for nurse practitioners and certified registered nurse practitioners, and universal recognition which includes licensed healthcare professions.

Regardless of the outcomes of the upcoming elections and the ACA legal challenge, one thing can be counted on: There are no silver bullets to the problems of healthcare access and affordability. Fortunately, states can lead the way in empowering individuals and families to best meet their own needs and preferences by allowing for more options for care and a robust healthcare workforce.

Naomi Lopez is the Director of Healthcare Policy at the Goldwater Institute.



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