The most controversial part of Obamacare — the mandate that people buy health insurance — is also the glue that was supposed to make the whole scheme work.
An article appearing on lifezette.com, and other information provided by the Wall Street Journal details the mounting evidence that indicates the mandate is failing. The failure of the mandate is causing insurance companies to raise their premiums substantially for 2017.
Congress got insurance companies to go along with the Affordable Care Act in 2010 by striking a grand bargain — private insurers would accept new rules and restrictions in exchange for millions of new customers, many low-cost healthy people who would not break the bank.
The government offered subsidies to help lower-income Americans afford the premiums and threatened to fine people if they did not comply.
But the stick was not enough, and critics contend that the Obama administration weakened it further by wielding it with less-than-enthusiastic vigor.
“Nobody really wants to enforce it … Enforcing the individual mandate is going to hurt politically,” said a health policy counsel for the American Action Forum.
“The size of the penalty is not enough for someone who’s relatively healthy to think it’s worth it for them to pay for insurance,” said a senior research fellow at George Mason University. “Congress took all of the IRS’ enforcement tools away”.
- Although Congress authorized penalties for failure to purchase health insurance, it limited the ability of the IRS to enforce it. The agency cannot sue, file criminal charges, or place liens on bank accounts to collect. It can send a warning letter or withhold money from tax refunds — if the taxpayer is owed a refund.
The government could crack down. “But aggressive enforcement could backfire politically”, said a senior policy analyst at The Heritage Foundation. “In order to enforce this, it would be pretty ugly”.
- The analyst said it is not just the stick of enforcement that has proved inadequate — it’s also the carrot of insurance. He said it has been difficult to persuade young and healthy people “to pay for something they might not want or need … A lot of people value holding onto their own money and eating the mandate.”
The result is much lower sign-up rates than experts initially forecast. The Congressional Budget Office forecast 21 million enrollees by 2016. The Urban Institute projected 23.1 million. The Centers for Medicare and Medicaid Services guessed 24.8 million. And the Rand Corp. estimated 27 million.
The actual number was about 12.7 million. With attrition that occurs throughout the year, the number by the end of 2016 is likely to be 10 million to 10.5 million. The people who find the health plans most attractive are those who receive subsidies that cover most of the cost and those who use a lot of medical services.
- The Urban Institute report from January 2015 projected that 36 percent of enrollees this year would have household incomes below 200% of the federal poverty line, and therefore be eligible for a subsidy. The actual percentage was 66%.
But while the Urban Institute projected that a 25% of enrollees would have incomes above 400% of the poverty line and thus be ineligible for subsidies, the actual share is just 2%. As one analyst said, “If you have a really expensive medical condition, Obamacare made insurance a good deal for you,”. “If people spend their own money, they don’t value the product.” “We know that insurers have enrolled a much more expensive pool than they expected,”. “We know that because they’ve had huge losses.”
To make up the difference, insurance companies have increased premiums. Preliminary research indicates that the average increase was 15% to 16.5% between 2015 and 2016, and that the increase for 2017 will be “much worse.”
*Modified from a lifezette.com article, WSJ.com articles, and other data provided by various online sources.
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