President Trump might not mind if people starting calling Obamacare Trumpcare, because the controversial health program signed into law in 2010 is finally stabilizing.
After several years of sharp rate hikes, insurance premiums for people participating in Affordable Care Act exchanges are actually due to fall in 2019. The Trump administration says the average premium for a typical plan will drop by 1.5% next year. That’s based on rates insurance companies must file with the states in which they operate. About 9 million Americans buy insurance on an ACA exchange.
“There’s been a lot of tumult under the ACA up till now,” says Larry Levitt, a senior vice president at the Kaiser Family Foundation. “But there’s no question it’s viable, in the face of significant headwinds. The ACA is embedded in the health care system.”
Insurance still isn’t cheap. The average monthly premium for a mid-level “silver” plan under the ACA will be $406 next year—69% higher than the average premium just three years ago. But steadier rates indicate that insurers have finally figured out how to properly price the policies sold on the exchanges. When the ACA first went into effect in 2014, insurers underpriced their plans. That forced them to impose sharp price hikes in subsequent years. The dramatic price swings might finally be over.
Most ACA participants receive subsidies that protect them from price hikes. But people who earn too much money to qualify for subsidies, and don’t get coverage through an employer, have gotten clobbered with soaring premiums in recent years. A married couple in their 50s can easily pay $25,000 per year in premiums alone. About 6.7 million Americans buy unsubsidized insurance on their own.
[See what Trump gets wrong about “Medicare for all.”]
The stabilization of the ACA is actually an awkward development for Trump, who campaigned to repeal the law and has boasted that “piece by piece, Obamacare is just being wiped out.” Trump has tried to dismantle the ACA by cutting outreach and educational programs and killing reimbursements to insurance companies meant to cover the cost of low-income enrollees. Last year’s Republican-backed tax-cut bill killed the individual mandate requiring everybody to have health care coverage, effective at the start of 2019. That will probably reduce the number of people with coverage under the ACA.
More consumers approve of the ACA
Republicans, of course, came close to overturning the whole law last year—and may try again, if they retain control of Congress after this year’s midterm elections. Senate Majority Leader Mitch McConnell told Reuters recently, “if we had the votes, we’d do it.”
The public doesn’t actually want that, however. Approval of the ACA has gradually drifted up from a low of 33% right before the law went into effect in 2014, to 48% in the latest Kaiser Family Foundation poll. The disapproval rate was 40%, with 11% saying they don’t know. The law could get more popular once the individual mandate is formally gone, since that was one of the law’s most controversial measures.
Health care is turning out to be a potent issue in this year’s midterm elections, with 71% of respondents saying in a Kaiser poll that it’s a “very important” factor in terms of who they will vote for. That’s more than any other issue. Jobs and the economy, normally the top concern, came in second, with 64% saying it’s very important.
Democrats think they have the edge on health care, since they generally support the ACA, along with provisions that would make it work better, such as measures to make insurance cheaper for people who don’t qualify for ACA subsidies. And many Democrats now support some version of the Bernie Sanders “Medicare for all” plan, which would extend the health program for seniors to others who don’t have coverage.
Trump, for his part, has allowed more narrow insurance plans, which were generally banned under the ACA, as a way to let some people pay less for less generous coverage. But Trump’s administration has also joined a lawsuit seeking to overturn one of the most popular parts of the ACA—a provision saying insurance companies cannot deny coverage or charge exorbitant fees to enrollees with pre-existing conditions. The details are complicated, but if Trump’s side wins, some states will probably go back to the old rules of allowing insurance companies to charge whatever they want. The politics of health care seems to have a lively future.
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Rick Newman is the author of four books, including “Rebounders: How Winners Pivot from Setback to Success.” Follow him on Twitter: @rickjnewman