Winston-Salem Journal (NC) January 9, 2020
WASHINGTON
- The repeal of an unpopular fine for people without health insurance has had
little impact on "Obamacare" sign-ups or premiums, a gap between the
real world and legal arguments from conservatives again challenging the
Affordable Care Act.
The
10-year-old law has proved more resilient than its creators or detractors
imagined, even as the Supreme Court considers whether to take up the latest
effort to roll it back.
Opponents
argue that the constitutionality of the entire 900-page law hinges on the
now-toothless penalty for not having health insurance. Collected as a tax by
the IRS, the penalty was intended to enforce the law's "individual
mandate" that Americans be insured. A previous Republican-led Congress set
the fines to $0, effective last year.
"We've
gotten a lot of evidence by now about what the market looks like without a
mandate penalty, and on the whole it looks pretty stable, which is surprising
because that's not what most people would have expected when the ACA was being
written," said Cynthia Cox, who directs research on the health law for the
nonpartisan Kaiser Family Foundation.
A
Kaiser study released this week found that removal of the penalty pushed
premiums up about 5% going into 2019, but the bottom line was a wash because of
other factors. Insurers appeared to be making healthy profits.
The
penalty was thought to be critical when the law was being written in 2009-2010.
The idea was to nudge healthy people to sign up, helping keep premiums in
check. But Cox said there's no indication that healthy people have dropped out
in droves.
In one
telling statistic, the Kaiser study found that average hospital days per 1,000
people enrolled dipped slightly in 2019, even after the penalty was eliminated.
Partial
sign-up numbers for 2020 released Wednesday by the government point to
stability. Nearly 8.3 million people enrolled in the 38 states served by
the federalHealthCare.gov website,
down only about 2% from last year. A final count including states that run
their own sign-up efforts is expected by the spring.
The
insurance mandate was the central issue when the Supreme Court first upheld the
health care law in 2012.
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