Budget Office Lowers Its Forecast for Obamacare Enrollment

The problem with the ACA is that it is expensive to get comprehensive care. Insurance with a high deductible (catastrophic insurance) is less expensive but really does little to help except in the case of a disastrous medical problem. Most people need care that covers prescription drugs and visits to a primary care physician when they are ill for a reasonable fee, and cannot afford or justify insurance that costs more than $1,000.00 for one adult. What we need is universal insurance (Medicare for all or similar) so people can go to a doctor when they need to, before a medical emergency. Why healthcare should line the pockets of insurance executives or doctors in baffling. It also results in a poorer quality of care.

The ACA is poorly designed because it is a product of multiple political compromises. In addition, there are significant segments of the population who are eligible but not enrolled. These include homeless people, people with psychiatric disorders and people with substance use disorders. There is no presumptive eligibility for those who are disenfranchised by virtue of their disease or their socioeconomic status. Finally, because there is a more or less finite number of people in each state, the rate of growth will slow over time because the number of people enrolled will increase and the number of people not enrolled will decrease.

The process of selecting an ACA plan is complex and confusing. Premiums, deductible, copays, provider networks, subsidies, and verification of household incomes. A Rube Goldberg contraption if ever there was.

Research from behavioral economists document when faced with complex choices and data overload, typical consumers will simply default. This is why vanilla is our favorite flavor. The default with Obamacare is not apply. I've seen well educated business people simply give up and walk away.

I've seen smart people stop paying their premiums because the physicians/hospitals they were assured were in the provider network in actuality aren't, customer service representative who don't provide service, regulators do nothing about inadequate provider networks or the specialist needed in the plan's network can't give you an appointment for months and you have to go to another city and the drug plan doesn't actually pay for the drugs a physician prescribes. This is an endless circle within a circle that is one barrier after another. Back to Rube Goldberg. The policy wonks couldn't design a mechanism the insurance plans couldn't game to discriminate against the sick. Health insurance is like the Vegas House, the odds are they will win and the patient will lose.

So people simply walk away and hope the don't have an accident or a lump or chest pains or some other misfortune because they chose the wrong gene pool.

The article doesn't tell us how many ACA purchases are individuals who had insurance but were forced on the exchanges. Medicaid is soaring because it is free to the recipient. Wait till the bill comes due. Many states such as Illinois and California are teetering under the cost of Medicaid, a system that pays very little for care but costs an enormous amount of money.

This week I had to listen to the anger and frustration from my son age 26 who is furious that his insurance appears to cover nothing. He plans to drop his insurance and has been blaming me for encouraging him in the waste of money. I told him to call his senators and congressman to let them know what is going on. Before the ACA changes I had insured him more cheaply and with significantly better coverage than what he can find now that he's aged out of my coverage. Trust me, the numbers will go down as more of these kids realize they've been rooked.

Look, ACA is nothing more than a health care redistribution scheme and a poorly designed one at that. There are thousands of low-cost walk-in clinics around the U.S. that can provide attention for the minor problems that used to clog ERs. Walmart charges $65 or less for a visit. If the tax penalty gets higher, the combination of walk-in clinics and catastrophic insurance is a better deal than the expensive ACA alternatives. There are free market choices, but the ACA is killing them. Under the ACA, only people under 30 and people of any age with a hardship exemption from the requirement to have health insurance can buy catastrophic insurance plans.

The great, guiding hand of the all-seeing, all-knowing government bureaucracy has replaced individual decisions.

My prediction - when the tax penalty becomes more significant and people become aware of it, there will be so much outrage that the penalties will be severely reduced or eliminated, bringing down the whole house of cards that Obamacare created.

Not a word that ACA is costing more then originally thought. Not a word that healthy, young people are staying way, which are desperately needed to balance the costs of the older, sicker people left in ACA. Not a word that this scenario starts the death spiral. Not a word that Medicaid expansion is costing states far more than expected, busting their budgets, crowding out funding for education, infrastructure and other important matters. And to think Medicaid is a terrible health program too! It is rife with fraud and one that many physicians avoid participating in because of the bureaucracy and inadequate payments, often lower than their costs to treat patients.
Congress could have helped the uninsured with a much less intrusive and expensive plan but instead decided our healthcare should be micromanaged by federal bureaucrats -- just like the scandalous VA.

From everything I have read, the vast majority of ACA enrollees are either in Medicaid or in highly subsidized plans. Which just goes to show that if you give something away for free, you will have customers.

I'm all for healthcare as an inalienable right - as long as someone else is paying for it.

I'm in my 2nd year with Obamacare. For my doctor visits, copays are about the same as those with employer sponsored health coverage. However, deductibles are high and will stay that way until this country decides that everyone has a right to health coverage at a reasonable cost. For those that refuse to purchase Obamacare and instead pay the penalty, hurray for you but whatever you do, don't get sick. Personally, I can't see paying a penalty (even if it is cheaper than premiums) and then get absolutely nothing out of it. Obamacare is not perfect but better than the "old days" and during its implementation 3 years ago, it was tremendously watered down by Republicans (I'm a republican by the way). Is single payer the right answer? I don't really know but I do know that before Obamacare, most of us wanted the free market to handle coverage. Well that never worked unless you were able to pay the extremely high premiums or were covered by your employer. How can anyone say that if you cannot afford health care coverage, tough luck. Going back to the old way of using the emergency room for everything is not the answer either.

B Minneapolis is technically correct but practically inaccurate about exchanges and commissions to brokers (see previous response in reply). Insurers pay brokers commissions for marketplace enrollments. Commissions are built into rates. If you don't have/use a broker, that dough drops to the insurer's bottom line.

Obamacare is a failure, leaving 30 million uninsured and most of the rest of us underinsured. We have to vote for Sanders with a single party payer system and Medicare reform. Only the insurance companies will lose.

When it comes to evolution, I'm in the natural selection camp over biblical creation. All the way.

When it comes to global warming, I believe there is a man-made component over 100% natural causes - the hand of god.

When it comes to the ACA, possibly the worst piece of legislation ever constructed, we ask: Incompetence? Or Intelligent design? - designed to fail and insure single payer. I'm skeptical, but leaning towards intelligent design.

Let the ACA deniers show themselves!

Hey, guess what?

I didn't enroll again this year.

Wanna know why?

Because once again the tax penalty will be far cheaper than the insurance premiums I would have to pay for some service that provides me with absolutely nothing. In turn, I'd rather waste less of my money on a tax penalty than waste more of my money on some greedy money-hoarding for-profit insurance company. Either way, I get absolutely nothing out of the deal, so why waste more, when I can save more?

Truly, it gets to a point where the ACA was and is a failure. Congress could have passed a law that stopped insurance companies from discriminating against people with preexisting conditions and allowed young people to stay on their parents' insurance longer, and simply stopped there.

Those are the only two groups of people happy with the law.

Everyone else hates it, including me, a two-time voter for President Obama.

The phenomena can be summed up in two words: exorbitant deductibles. The insurance industry's gaming ACA with deductibles so high they are the equivalent of what a relatively healthy person would pay out of pocket makes people both beholden to premiums AND effectively pay out of pocket for their healthcare. It's a lose lose proposition, all the more so the lower your income is. Insurers are still crooks like they always were, they just have new tricks designed to milk the most they can from the gift of ACA.

The penalties for not having health coverage need to be dramatically increased, preferably to the level of the cost of the cheapest unsubsidized bronze level coverage. That would eliminate much of the free rider problem, as people would purchase coverage were it the same cost as not purchasing coverage. In addition, the penalty should be collected aggressively, not just from federal income tax refunds. That, too, would increase participation. The same people with Playstations, smartphones, cable TV etc. can't claim that there isn't money in the budget for health insurance.

In response to B in Minneapolis:
No one is suggesting Americans who earn too much shouldn't use the exchanges- it's just what's happening. And insurance brokers make commissions signing up exchange customers, something you do not seem to be aware of.

This is just an unintended effect. But it's bound to have an impact.

The problem with the middle ground in the market - people who make too much for the medicare expansion or have been denied it by their states - is perfectly understandable. Of course, everyone who is presently healthy would prefer to delude themselves that they will remain so, without needing to make hard choices in their budget to make space for health insurance payments, even if subsidized. Most people I know who complain about the cost of ACA subsidized health care insurance - I'm not talking about the genuinely poor who can get expanded medicare coverage - are spending to the limit of their credit and beyond on an endless stream of consumer junk, all of which they consider "absolutely essential" but most of which really counts as shopping as a mode of entertainment. The idea that they cannot make room for health care insurance is laughable. Isn't it perfectly marvelous how everyone found money in their stretched-to-the-limit budgets to pay and pay again for digital connectivity and services of every sort, where once TV reception was free and phones a dirt cheap MA Bell monopoly? It's the familiar free-rider problem. If people can evade signing up under the ACA until they are actually sick and drop out after they are successfully treated, costs rise for everyone. It's why the tax penalties for remaining uninsured are an essential part of the overall economics of health care reform and need to become sufficiently stiff as quickly as possible.

For people who are not entitled to a subsidy but buy insurance on the individual market there is no reason to deal with the cumbersome process of signing up on the exchanges. Far better to go to a broker and have an advocate to call on when a problem arises with an insurance company.

The exchanges, as an insurance broker recently told me, have become the place for the poorest Americans to buy insurance, those entitled to the largest premium and cost sharing subsidies.

Thus, the lowered enrollment projections. We have created two markets and it's anyone's guess how this will all fall out as premiums and deductibles rise and networks and benefits continue to narrow.