What Obamacare Will Do For (Or To) You

Conservative and libertarian health policy experts weigh in.

Whitehouse.govWhitehouse.govIt’s a very big day for American health care: Today, the health insurance exchanges called for by the Patient Protection and Affordable Care Act—a.k.a. Obamacare—open for enrollment, offering coverage that kicks in at the beginning of next year.

The exchanges are the core component of the largest and most transformative overhaul of the U.S. health system in decades, and the vehicle for the law's massive expansion of health coverage. And yet, despite the fact that Obamacare has been law since 2010, no one knows quite what to expect as these government-run insurance marketplaces open for business.

Critics have warned of disaster, pointing to a slew of delays and technical troubles with the exchanges, and Congress has allowed the federal government to enter a partial shutdown as a result of conflict over the health law. Supporters of the law have promised that Obamacare will usher in a new age of widespread affordable coverage. But even President Obama has admitted that the rollout won’t be without its “glitches and bumps.”

Over the last week, I asked a half dozen conservative and libertarian health policy experts what to expect from Obamacare in the coming days and months, and in the years beyond. Here’s what they told me. (Quotes have been condensed and edited for clarity.)

On Opening Day

James Capretta, Ethics and Public Policy Center Senior Fellow and Former Bush Administration Health Official: “On October 1, you're going to see a very uneven beginning to the program. Some states are going to be largely ready to go and have a big presence on the ground to get people signed up. And then in some states, literally nothing's going to happen for a while. There may be a start up process on Oct 1, but there aren't enough people on the ground to know to actually do anything about it. So, I don't think there will be much enrollment in the early days or weeks. You're going to have a very uneven regional aspect to this, where some places it's up and going and some places it's literally it's a dead stop still.”

Michael Cannon, Cato Institute Director of Health Policy: “When it takes full effect in January and all 50 states start to receive those subsidies, you're going to have millions and millions more people dependent on government health insurance. And you're going to have an industry receiving an even larger chunk of its already bigger revenue stream from the government, either directly or indirectly through implicit taxes. So if Obamacare takes full effect, it will vastly expand the constituency for higher taxes and greater government spending on healthcare.”

Devon Herrick, National Center for Policy Analysis Senior Fellow: “I'm not sure if anyone really knows what to expect. But what we wonder about is that the administration—and the insurance companies as well—is very concerned that when the exchange is opened the only people who will be lining up for coverage will be the early retirees, those who have preexisting conditions. And of course to keep the Affordable Care Act premiums affordable the administration and architects, their goal was to get those healthy young invincibles—people who have few health needs that are willing to spend more than their expected cost—so the older, less healthy people could get coverage at a price they can afford and would like to pay. That's going to be a reach. A lot people are afraid the healthy folks may not want to enroll and pay more than their costs should be or would be otherwise so that someone else gets a better deal.”

On Health Insurance and Premiums

Avik Roy, Manhattan Institute Senior Fellow and Romney Campaign Health Adviser: “Although there will be rate increases across the board under Obamacare, the biggest rate increases, and the rate increases that we're focused on here, are rates for people who shop for coverage on their own… Obamacare supporters excuse the rate increases, saying, well there's going to be subsidies and everyone will get subsidies so it doesn't matter that Obamacare drives up the underlying cost of healthcare. That's just not true on multiple levels. Subsidies aren't free. Taxpayers pay for them. They don't just magically fall from the sky. The subsidies really only benefit really poor people. Yes, there are a lot of middle class people who are eligible for subsidies, but the scale of subsidies that are available for people in the middle class and lower middle class as opposed to truly poor are relatively low and won't compensate for the dramatic increase in health expenditure and health insurance premiums people will see.”

Devon Herrick: The Department of Health and Human Services released a report saying average premiums would be around a hundred bucks for the cheapest bronze plan for 27 year olds who make about $25,000 per year. What I noticed about that was that young people who are making about $25,000 a year—even after the subsidy, that's an iPhone data plan payment. And some of those may think the iPhone data plan is more important than the coverage for a bronze plan that wouldn't really help them necessarily with what they need, which is an occasional doctor's visit.

Tom Miller, American Enterprise Institute Resident Fellow, Former Senior Health Economist with the Joint Economic Committee: “We have all kinds of projections about what the enrollment mix will be. People are just guessing on that front. There's no airtight result on that. And that'll make a big difference in terms of what will end up being the premium results.”

Michael Cannon: “The safe money is that it's going to increase the number of people with healthy insurance. But it could also decrease the number of people with health insurance as more people figure out, hey I can game the system, I can wait until I'm sick to buy insurance.”

On Implementation Challenges

James Capretta “Comparisons [between Obamacare’s rollout and Medicare Part D] are not very useful in the sense that the Medicare program already had an ongoing, direct relationship with its beneficiaries because of the rest of Medicare. They already knew who these people were. They had a communication structure already built to communicate with the Medicare beneficiary population through various means. They were able to build this infrastructure on the foundation of an ongoing communication relationship. There is no such foundation for the implementation of this law. Most of the people they're trying to reach are not connected to any kind of government benefit or system. They're trying to bring them into a system with which they'd have no existing relationship with. That's an entirely different proposition. It’s much, much, much harder.”

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  • VG Zaytsev||

    TL:DR

    Obamacare is horrible but teh republicans are crazy teabaggers for trying to stop it.

  • ||

    It's not that they're trying to stop it. It's that their methods of going about trying to stop it are stupid and likely to fail.

  • fish||

    You expect different from TEAM BOEHNER?

  • grey||

    Trying to stop something terrible = terrible people? WTF. I have plenty of axes to grind with Red Team, but their sloppy politics isn't high one of them. The problem isn't their trying, its the progressives who passed it, promote it, and won't "fix" or repeal it. Put the blame where it belongs, then we can Red Team hate for all their statist positions.

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  • Biden's Scroteplugs||

    Today, the health insurance exchanges called for by the Patient Protection and Affordable Care Act—a.k.a. Obamacare—open for enrollment, offering coverage that kicks in at the beginning of next year.

    this appears to be untrue.

  • Auric Demonocles||

    I've still yet to see what about these exchanges is supposed to make insurance cheaper.

  • RBS||

    You have to sign up for it to see what's in it.

  • Biden's Scroteplugs||

    be careful about agreeing to the Terms of Service Agreement. these guys have guns.

  • John||

    They generally don't. The entire system is designed to make insurance cheaper for people who are sick, old or poor. To do that, they are forcing people who are not that to pay more either through buying insurance when they don't know or adjusting their policy via mandates to cover more things and thus cost more and subsidize the insurance of more people.

  • VG Zaytsev||

    Don't old people get Medicare and don't poor people get Medicaid?

  • John||

    Yes. It is an interesting question who really benefits from this. The small number of people with pre-existing conditions not covered right now would be one group. I think people who are poor enough to get the full subsidy but don't get medicaide right now. People who have insurance but pay a lot for it to cover some chronic or rare disease they have now.

    But the numbers of people who will actually benefit from this seem to be really small. The Washington conventional wisdom is that enough people will benefit from this that it will be impossible to repeal. But I have yet to hear exactly who these people are supposed to be. I sure don't see who they are.

  • VG Zaytsev||

    If the proggies really cared about people with expensive pre-existing conditions they could have done some subsidy for those people or expanded medicare to include them. Same with the mythical poor people to rich to get medicaid but without other coverage.

    The whole program is a complete abortion. Totally ill conceived from the beginning.

  • John||

    Yeah, that is a pretty small problem. And most of it is taken care of via charity hospitals and bankruptcy and such. The Progs fucked up everyone in America's health insurance to solve the problems of a comparatively tiny minority.

  • #||

    Also if they were interetse din understand who the unisured are, they would realize that most are only that way tmeporarily due to being young and just entering the workforce, losing their job, going threw a divorce or something of that matter. Over 60% of the unisured are insured within a year.

    They could have dealth with this if they wanted be replacing the stupid COBRA system with a subsidy for short term catostrophic insurance to go along with unemployment.

    There were so many other ways this could have been done, even if you accept that the government needed to get more involved instead of letting markets work. But their aim was never to patch holes in the most cost effectuve way. Their goal has always been to outright nationalize insurance.

    The community rating/ guarenteed issuance socialized costs and then the public option was supposed to be the trojan horse that crowds out all the other proviers over time as its given subsides and regulatory preference.

    Instead they just have this clusterfuck that is going to benifit a small slice of the population while exaserbating all of the current cost and shortage problems and making the budget situation worse.

    Like I said to you John a few days ago, this will nto be the end of the world come Jan 1, but it is going to be really shitty and will progressively get worse as time moves on.

  • wadair||

    If and when the Dems get control of the white house and the legislator again, we will likely get the public option.

  • WTF||

    Because it's not really about solving problems, it's about a vast expansion of government control.

  • AlexInCT||

    Obamacare, contrary to the lies used to sell it, was not passed to make healthcare more affordable or accessible. This thing was created to destroy the existing healthcare system in this country, by destabilizing everything about it, through overload. Once that happens the progs hope that people will accept the only option left: the shitty government controlled and politically abused single payer system they could never get people to accept otherwise.

  • John||

    You give them too much credit Alex. It was passed because they felt they had to pass something and they had no idea what they were doing. Sure, the progs post hoc are going to say the plan all along was to create single payer. But at the time they thought this was a good idea.

    The bet is will this disaster cause people to demand more government and embrace the criminalization of private medical care or will this cause them to reject more government and to demand their old insurance coverage back. It is anyone's guess what that will be.

  • Rich||

    I sure don't see who they are.

    Patience, John. They'll be sitting next to Michelle at the SOTU Address.

  • John||

    That kind of stuff only plays well when everyone thinks the person is being helped with someone else' money. When people find out is their own money doing it, the sympathy well is going to run dry pretty quickly.

  • AlexInCT||

    I love hearing the young progs that voted for Obama at work now acting all pissed because they are about to lose a big chunk of their paycheck to this shit. And they don't even know that it is going to get even worse for them. At least I get to savor their tears...

  • sloopyinca||

    But they don't see it that way. They are gonna blame the insurance companies, big pharma and corporate "fat cats" for any problem that arises from it. And then they'll demand single-payer.

  • John||

    I don't think so Sloopy. I would agree with you if they hadn't been happy with their insurance before this. That is the big lie that progs told themselves, that people were really unhappy with their insurance. That was complete bullshit. The vast majority of people in this country were happy with their personal health care insurance and care. For that reason, they are going to blame this on the government. The problem is the Progs have sold this thing so much that they now own the entire healthcare system. Any change for the worse is going to be blamed on this program.

  • sloopyinca||

    Sure thing, John. It's not like the media aren't already spinning any problem as the result of GOP intransigence.

    I'm sorry, but it's not about reality, but rather about perception. And the perception is gonna be that the flawed system will have failed because the Team Red boys sabotaged it and the solution is to take them, and the evil corporations, out of the equation and go to a single-payer system.

    It's a proven formula.

  • John||

    That is not really a proven formula Sloopy. What is a proven formula is to create a system that hands out checks and goodies to the middle class while hiding the cost of doing that from them. That is what Social Security and Medicare are. Those things don't fail. They worked as advertised. Sure they are going to bankrupt the country. But that hasn't happened yet and the prospect doesn't really affect anyone directly right now. And the checks we hand out do.

    This thing is totally different. It is going to fail at every level. It isn't going to make anyone's life better. So they are going to have a hard time selling it or blaming how much it sucks on the evil Republicans.

  • VG Zaytsev||

    Yep,

    Although the republicans do need to keep blaming the problems on the proggies instead of rolling over and playing dead like a bunch of pussies.

  • JWatts||

    That is what Social Security and Medicare are. Those things don't fail. They worked as advertised. Sure they are going to bankrupt the country.

    Social Security and Medicare work fine as designed. To support the eldest 3-5% of the population. The system is struggling now, because we are trying to support a far greater number of elderly. The over 65 population is currently 13% and the percentage is growing.

    The fix is simple, raise the retirement age. Technically, it's gradually going up to age 67. But the number needs to be somewhere in the 70-72 age range. At some point the obvious fix will occur.

    However, what the country can't afford is another major entitlement program that's a bottomless money hole.

  • ||

    There's also a problem in that the medicaid expansion means that a lot of people will get kicked into medicaid instead of qualifying for subsidies.

    So you're going to have a large group of people whose coverage may get WORSE because they no longer get employer-based care and are too poor to get subsidies. They'll end up getting pushed into the underfunded Medicaid system which their family doctor may not even accept.

  • ||

    Added: especially people whose work hours are reduced to keep them part-time. There's going to be this huge class of part-time workers who don't get health coverage who will be forced into Medicaid.

  • John||

    That is an excellent point. This thing really is a national tragedy. I don't use that word lightly. Millions of people are going to see their lives get worse. The only issue is will they stand up and doing anything about it or will they let the media bully and lie to them such that they don't stand up.

  • wareagle||

    I think you the answer to that. Anyone likely to stand up and say something has already done so.

  • Francisco d Anconia||

    Millions of people are going to see their lives get worse.

    Hey, that's what the government does best.

  • John||

    It is the one thing you can always count on about government Francisco. It will always make lives worse.

  • AlexInCT||

    Prog pols to the sheeple: Can't make an omelet without cracking a few eggs... So you can't get single payer without destroying a whole bunch of little people, but hey, it's worth it! Trust us...

  • Sevo||

    John|10.1.13 @ 11:24AM|#
    "Yes. It is an interesting question who really benefits from this."

    Naah. New government employees.
    This is the deep well of patronage for the next 50 years, if it doesn't bankrupt the host before then.

  • Restoras||

    Sure but the government needs healthy young people to provide more work and wealth for the transfer payments.

    Oh, and don't forget, since the exchanges do not provide health care but instead provide insurance you can bet your last self-installed catheter the insurance companies are making money on it too.

  • VG Zaytsev||

    It's really hard to conclude that anyone other than the insurance companies are going to be net beneficiaries of this program.

  • John||

    Sure they will. They will make money in one of two ways. If they can, they will make money by forcing people to pay for shit they don't want or need or more for what they already have in the form of higher rates. If people refuse to do that and just stop insurance and pay the fine, then they will make money by cutting medical care available.

    You will see both things. You will see some of both. And most people will be noticeably worse off in significant ways. The progs have finally let the mask slip and gone directly after the middle class and come up with a program that makes no secret of its goal to make things worse for the middle class. We will see how well that works out for them.

  • AlexInCT||

    The collectivist utopian system is classless, as in their utopian world all people belong to the same class. Well all people but the masters.

    Progressive utopia will have the well off masters and the rest, which from history we see will all live in shared misery (the only standard of living government can guarantee to provide us). Kind of like the USSR, North Korea, and any other such paradise of the people did...

  • wadair||

    Yes, all people will belong to the same class because the middle class will be destroyed. Or was that what you meant?

  • Brandon||

    The government, being unproductive and thus a zero-sum game, sees everything as a zero-sum game. Thus, they don't believe that the market can possibly be made more efficient, so they just transfer costs to the people least likely to object instead.

  • Lady Bertrum||

    It may be cheaper for people who purchase insurance in the individual market (not group or employer based) who are old and/or already sick.

    It'll be more expensive for the young and/or healthy.

  • #||

    Yeah this is the other part. It basically socializes costs in the individual market. If insurance is currently really expensive for you, it likely goes down. If insurance in currently cheap for you, then your premiums are going up.

  • JWatts||

    It'll be more expensive for the young and/or healthy.

    Really, it will be more expensive for the currently insured population. It will be a lot more expensive for the working young and/or healthy

  • Pro Libertate||

    I heard a guy on the radio today who said that his employer-provided insurance--here in Florida--was going up over 70%. Ye gods.

  • robc||

    Over 80% was the number I got from my insurance company.

    But, it looks like I can keep my current policy for 1 more year, so it might not be that bad.

    And that gives a year for something to happen.

  • Pro Libertate||

    My tummy hurts.

  • robc||

    This was for the plan they offered as a default that is the "nearest" to my current plan.

    80% more expensive with a LARGER deductible and a LARGER annual max out-of-pocket expense. How the fuck is that possible.

    Oh, yeah, it covers me if I get pregnant now.

  • Pro Libertate||

    Stupid fucking law enacted by stupid fucking people.

  • Lady Bertrum||

    Jesus, Mary, and Joseph. I sincerely hope that you're able to find a solution that doesn't raise your premiums by 80%. That's un-fucking-forgivable.

  • Pro Libertate||

    The problem may be that the crap option, with low services, high deductibles, may cost nearly as much.

    We're well and truly screwed if this law isn't removed from the books.

  • robc||

    I might have options.

    1. It looks like they cant renew my old plan after Jan 1, but if I renew Dec 1 instead of Jan 1 I can have it thru 2014. Which is stupid, but okay.

    2. There is another plan with a much higher deductible that is offered that might be reasonably priced. I havent been able to get a number yet.

  • UnCivilServant||

    That's nothing, mine jumped 250% out of pocket cost.

  • AlexInCT||

    He is lucky if it only goes up by that much. Mine already is there. And that is, if my employer doesn't decide the whole thing isn't worth it, and throws us all to the Obamacare exchanges/wolves.

  • Yellowrose||

    My insurance here in nebraska is going up $200/month, not sure of the exact percentage (mainly because the percentage doesn't matter), just the fact it went up is bad enough. Now I get to look for either a part time job or more hours at work. I also read another article somewhere, it showed women in my age group as a whole in nebraska, the insurance is going up on average 276%!!! That's a dang shame if you ask me

  • Lord Humungus||

    unicorns and rainbows, duh.

  • #||

    It doesnt make it cheaper. It's just a conduit to hand out subsidies base don income. The system as a whole drives premiums up, then they tax a bunch of people to grant subsides to others to reduce the increase in premiums.

  • kinnath||

    Obamacare is welfare by deception. It increases insurance costs on most people to allow low premiums for high-risk people that would be otherwise un-insurable.

  • Francisco d Anconia||

    Stop calling it insurance. When you tell a company they may not take pre-existing conditions into account, it STOPS being insurance and becomes welfare.

    Reduce costs...

    *shakes head in disgust*

  • kinnath||

    In stereo!

  • kinnath||

    Singing Bye Bye Miss American Pie

  • PD Scott||

    I thought this was pretty good: Obama explains Obamacare (from the Conan show).

  • Brian||

    The point of Obamacare is to miserably fail at all of its stated goals, so that we can move on to a single payer system. End of story.

  • AlexInCT||

    ^^^^^ THIS^^^^^

  • #||

    The other important thing here too that I hadn't quuite though of previously - because there is now a price control in place that prevents companies from charging based on risk, insurance companies in the excahnges are trying to compete amongst themselves on how less attractive they can be to already sick people. And the way they are doing this, is by keeping the provider networs small so that only people who don't use much healthcare find it attractive. If all companies do this, it doesnt really have an effect, but no one company wants an expansive network so all the sick people sign up, driving the plan premium up, causing all the healthy people to leave and ending in a death spiral. So the new equilibrium in the individual market are plans that don't let you get healthcare at very many facilities. Essentially the policy has just made everyone purchase the same shittier insurance.

  • Lady Bertrum||

    +1

  • sloopyinca||

    Read this bit of idiocy by Fournier about the shutdown.

    FTA: 2. President Obama can't capitulate to GOP demands to unwind the fairly legislated and litigated Affordable Care Act. To do so would be political malpractice and a poor precedent for future presidents.

    Calling that "deemed to have passed" monstrosity fairly legislated is like saying the rape of a deaf-mute is consensual because she never yelled rape.

  • John||

    It was like I was trying to explain to Tony on the other thread. There is nothing new about this. On a smaller scale, there are several things my clients at work have the authority to do but don't do because a subsequent Congress decided not to fund them to do it. This is no different than Congress killing funding for a weapons program or anything else.

    This is how government works. If you don't control both houses of Congress, sometimes your pony will get its funding cut off. You either have to bride the Congress with something else to get your pony funded, or live without funding until you can take back both houses of Congress and get it funding.

    It is completely mendacious for people to claim that this is some kind of new or unprecedented action by the House.

  • sloopyinca||

    It is completely mendacious for people to claim that this is some kind of new or unprecedented action by the House.

    Well, duh. But that's never stopped them before. These are the same people that liken the NRA to terrorists and peaceful abortion protesters to Nazis. And their pals in the media will report it the way they're told...because the majority of them are true believers as well.

  • fish||

    It was like I was trying to explain to Tony...

    It's statements like this that undermine your credibility.....why not just show your dog a card trick...the end result is the same.

  • JWatts||

    It's not that Tony, personally, is worth the time to explain the point to, or to address the issue he's raised. It's the hundred other readers that aren't ideologically blinded and would like to see the issue addressed that you are really speaking to.

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  • A Secret Band of Robbers||

    I am SO SICK of these fucking Suderman puff pieces trying to make Obamacare look good so his friends at MSNBC keep inviting him to the cocktail parties.

    And Megan McArdle is tall! Ha ha!

  • robc||

    KY exchange website is failing today. Shock and awe.

  • KDN||

    Unprecedented demand! Unstoppable popularity!

  • bmartin||

    Obamacare will mirror the Federal Tax Code in unfairness and complexity. I currently run two small businesses and spend over $4000.00 a year for tax filing and preparations. In my recent years my wife and I have had the (pleasure) of filing for financial aide for our children's college tuition. It is impossible to communicate the burden of paperwork that we face on a daily basis. The bureaucracy at the local state and federal level is sucking the oxygen out of the air. I have been self employed and self reliant for over 35 years. It is hard for me contemplate that we are not well beyond the tipping point of no return.

  • coma44||

    And just think what it takes to start a business now. I am working on doing that and the mountain gets steeper and higher with every hurdle I clear.

    Both Republican and Democrats have killed this country and none of them will ever pay the price.

  • Will Nonya||

    I think we're forgetting one of the key benefits of Obamacare. Thanks to this law we'll all be healthier thanks to those free, frequent and through rectal exams we get when the government shoves its head up our ass.

  • coma44||

    "Obamacare supporters excuse the rate increases, saying, well there's going to be subsidies and everyone will get subsidies so it doesn't matter that Obamacare drives up the underlying cost of healthcare"

    So I get to pay higher Taxes then the royal family will "give" me some back based on what I "earn" but since I am single, white male with a job that pays more than 50k I will get NOTHING back.

    Yea I am going to support this theft cause it makes me feel so needed. Why are we not in the streets hanging these thieves from the highest trees.

  • James Taggart||

    The American voters chose Obama and, consequently, Obamacare. And they deserve to get it - good and hard.

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