For months, we’ve been told that the impending implementation of the Affordable Care Act (aka Obamacare) will lead to soaring healthcare costs and more expensive premiums. That narrative has taken hold, even for those who otherwise support the suite of reforms. And that’s why the recent front-page article in the New York Times, reporting that premiums in New York State may actually fall 50 percent or more, came as such a surprise.
Only a few weeks prior, the Wall Street Journal announced that “Healthy consumers could see insurance rates double or even triple when they look for individual coverage under the federal health law later this year.” Their analysis did acknowledge that ailing individuals could see rates fall, but the driving point was one that has been made ad infinitum by critics of the reforms: costs will soar.
So entrenched is that view that the Republican-controlled House of Representatives continues its quixotic quest to repeal the bill, and voted this week for the 38th and 39th times to repeal parts of the bill, including the “employer mandate” that the Obama administration has already decided to delay. Paul Ryan said about the latest vote: “This law needlessly raises healthcare costs. And this law will cause millions of people to lose the health insurance that they have, that they want to keep.”
The debate distills to this: Can a bill that depends on an uneasy blend of free-market incentives and government regulation succeed in providing universal access to healthcare at a reasonable cost? The premise of the act in the first place was that a system of healthcare exchanges would encourage competition and keep prices moderate even as the pool of insured people expanded.
But that assumes that states implement it in good faith. The staunch opposition of Republicans has meant that many states with little regulation of insurance companies or healthcare are delaying or actively resisting many aspects of the bill. What’s clear is that opposing the bill is a good strategy if you want the reforms to fail. The success of the legislation depends on the cooperation of state governments, insurance companies and federal regulators. That is hardly unusual, but the complexity of the reforms make it all the more imperative.