September 06, 2016
No one expects NYT columnists to have any knowledge of the topics on which they write, which is a very good thing for David Brooks. In his column belittling the impact of the Affordable Care Act (ACA), he never once mentioned the requirement that insurers charge everyone the same premium, regardless of their health.
Brooks focuses on the health care exchanges, which do in fact have fewer participants than expected. The main reason for the shortfall is not that fewer people are being insured, as Brooks implies, it is rather that fewer employers dropped coverage than expected. (Brooks also repeats the silly “young invincible” story, that the problem is too few young healthy people signing up. The exchanges need healthy people, and it is actually better if they are older healthy people, since older people pay higher premiums.)
Brooks argues that the exchanges are disproportionately drawing lower-income people, which makes them another low-income program, like Medicaid, rather than a universal program like Medicare. Apparently Brooks did not realize that the ACA also requires that all insurers charge patients the same premium regardless of their health condition. This was a huge change in the insurance market since it means that even people with serious health problems, like cancer survivors and people with heart conditions, can get insurance at the same price as anyone else of the same age.
Before the ACA, these people could expect to pay tens of thousands of dollars a year for insurance, if they could get it at all. As a practical matter, this meant that before the ACA most people really didn’t have insurance against serious health conditions. Often these conditions would force a worker to leave their job, which was generally the source of their insurance. Once they left their job, they would then be forced to buy insurance in the individual market where insurers could charge them a premium based on their health condition. The ACA fundamentally changed this situation, but apparently Brooks never noticed.
Note: I wanted to get folks the actual data (bonus points to anyone who can get this info to Brooks before he writes his next column on the topic). In 2012, before the key provisions of the ACA took effect, the Congressional Budget Office (CBO) projected that the uninsured population would fall to 32 million by 2015. In fact, it fell to 32 million by 2014, a year in which it was projected there would still be 38 million uninsured people. According to data from Gallup, the number of uninsured non-elderly fell to less than 28 million by the fourth quarter of 2015.
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