Popularity and rough edges

The Kaiser Family Foundation just released their Health Tracking poll for November.  The ACA is increasingly popular.


What is driving that popularity?  We know that the ACA got more popular in 2017 as people were faced with potentially losing the good things that the ACA does due to Repeal and (maybe) Replace.  But it is also an indicator that a lot of rough edges of the consumer/public facing experience have been smoothed off in the past two years:


Greg Fann, an actuary makes this point very clearly:


There are still a few significant rough edges of the ACA experience remaining are:

  • Medicaid expansion in hold-out states
  • 401% FPL and above affordability problem
  • Family Glitch

The ACA is an evolving law.  Congress is not particularly active in the evolution of coverage mechanisms but it has been active in the financing mechanisms.  The coverage mechanisms have been active due to judicial and executive action instead.  People are experiencing lower premiums if they are subsidized due to CSR strangeness or lower premiums if they are healthy and unsubsidized by the proliferation of underwritten plans.  Deductibles are still high and out of pocket maxes are scary but as insurers have figured out how to play the subsidy gapping game and the financing elements of the ACA disappear or are pushed back.  The experience and politics are different now than they were in 2014 or 2015.



9 replies
  1. 1
    Butch says:

    Well, the “good” thing about being laid off last June is that our income now makes us eligible for a subsidy; whereas previously I had to go with an underwritten plan because it was all we could afford, we’re switching January 1 to something that complies with the ACA. Still bronze, but doesn’t involve the (scary) limitations of the underwritten one.

  2. 2
    Pete Mack says:

    I suspect the difference is Trump: the prospect of losing the ACA made it a whole lot more popular than when it was stacked up against some hypothetical possibility of something better while Obama was still in office.

  3. 3
    r€nato says:

    The GOP is not actively demagoguing fear and loathing of ACA, that’s the difference.

  4. 4
    Yarrow says:

    I am so incredibly grateful for the ACA. Otherwise I’d be SOL. David, PLEASE post regularly for the next two weeks to remind people to sign up. We need people to sign up for the ACA to work.

  5. 5
    Kelly says:

    I had a conversation last week with a recently laid off friend regarding the 401% cliff. He’s always had good corporate benefits health insurance. His wife has job at a very small business without benefits. A serviceable arraignment for over 20 years but not so good now. He’s incredulous that $1 over the line and a $1300 subsidy goes poof!

  6. 6

    @Kelly: If they can pass underwriting, tell them to take a hard look at the short term plans after they speak with an agent.

    Some of those plans are junk, some of those plans are pretty damn good.

  7. 7
    Kelly says:

    @David Anderson: Her boss is looking into joining some kind of small business group plan and splitting the premium. He’s a good guy and acknowledges he been free riding all these years.

  8. 8
    Kent says:

    What is driving its popularity?

    For the first time EVER, Democrats actually campaigned in favor of the ACA across the country. Instead of ignoring or running from it.

    That kind of thing makes a big difference.

  9. 9
    Dan B says:

    Is there any signal yet on number of sign ups? Seems like I saw an indication they’re down. This would indicate a lot of hurt for low income and minority communities (My neighbors). It’s tough to reach them.

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