A year ago I said to my friend Mari, “We’re in for it now” enough times that she wanted to kick my teeth in. It’s December 2017, and we’re in it: tax bill signed, GOP congressmen calling for investigations into Robert Mueller’s own investigation and Uranium One, GOP and Donald Trump sewn together so tightly that they’re feeding KFC into the same shared mouth. I like to believe that the vaporizing of the individual mandate has not destroyed the Affordable Care Act.
“President Barack Obama’s signature domestic achievement,” the New York Times observes, “is becoming more like what conservatives despise — government-run health care — thanks in part to Republican efforts that are raising premiums for people without government assistance and allowing them to skirt coverage.” In other words, the poor get some form of access to health care while Americans who can afford or get it through their jobs are off it entirely.
While the marketplaces, or exchanges, have struggled with a series of problems since they opened in 2014, Medicaid, administered by an experienced corps of state officials, has gone from strength to strength. Public appreciation for the program has steadily increased as people come to understand its importance in the health care system, including its central role in combating the opioid epidemic.
And though Congress has effectively repealed the requirement for people to have health insurance, federal subsidies are still available to low- and moderate-income people who want insurance. The federal government pays, on average, about three-fourths of the premium for more than three-fourths of the people who buy insurance through the Affordable Care Act marketplace.
Even officials who work for local health providers have admitted that the subsidies are the incentives, not the mandate or penalty. Nevertheless, four million more Americans will be uninsured by 2019 and thirteen million more by 2027, according to the Congressional Budget Office.