The Supreme Court’s decision will make it much harder to extend health insurance to America’s poor.

[dkf]

Just what problems have we solved now that the Affordable Care Act has been upheld? We should rightly celebrate that no American will be denied the ability to get health care because of a pre-existing condition, and that many children will remain on parents’ health plans for more time.

But at its heart, the bill was designed to extend private insurance to the largest (politically) possible number of the now 60 million uninsured Americans, and then expand the public safety net for the remainder. To do this, the ACA comprises a “three-legged stool” of policies: a mandate for employers and individuals to buy health insurance if they can afford it, a prohibition on insurers from barring any buyers, and, finally, a massive expansion of free health care for the poor.

According to optimistic projections from the Congressional Budget Office, the ACA as written would only halve the number of uninsured—from 60 million down to 30 million—by 2022. Thus, even with the ACA safe, one-half of all currently uninsured Americans are still projected to lack coverage.

This is why it was difficult for me to care greatly about the presence or absence of the individual mandate, which was at the heart of the Supreme Court case. In all of Massachusetts, the laboratory from which the ACA sprung, only about 20,000 people—which is less than 0.3 percent of the population—were assessed penalties for not buying insurance, penalties that totalled less than $20 million. Forcing people to buy insurance did precious little; those without private insurance are mostly those who couldn’t afford it anyway.

So what does the ACA really do to expand coverage? Again, it’s worth examining Massachusetts. As I wrote back in 2010, the state reforms correlated with a drop in the percentage of the uninsured from 6.4 percent to 2.4 percent, or a gain in coverage for 233,000 citizens. Over this time, state Medicaid rolls ballooned by 276,000 people, indicating that the real driver for expanding coverage was almost exclusively a free giveaway of health care—that is, the third part of the three-legged stool. (Enrollment in private plans grew by only a paltry 2 percent.)

http://mobile.slate.com/articles/health_and_science/medical_examiner/2012/06/obamacare_and_medicaid_how_the_supreme_court_s_ruling_will_make_it_harder_to_extend_health_insurance_to_the_poor_.html

[NYC_SKP]

1. On balance, still a good outcome according to the author.

It's a good read...

"...In the end, I will certainly celebrate the Supreme Court ruling, because the ACA was the only serious effort any party put forward to tackle the deep moral problem of the uninsured. But my enthusiasm is tempered by the incredible obstacles that lie ahead."

~~

[dkf]

2. Interesting from a policy POV certainly.

From a purely non ideological pov the ACA does a decent job of attaining it's goals. But I still have a problem with the mandate.

[auburngrad82]

3. And 30 million more Americans will have insurance coverage nt

[dkf]

4. The article says it was mostly accomplished through Medicaid coverage in MA.

If governors balk at expanding Medicaid most of the expansion may not happen.

[NYC_SKP]

5. I think we'll only win this state by state in any event.

Including getting to a single-payer system: Vermont or California might lead the way with in-state programs, then more states will follow when it's seen not to be evil. I don't see it happening nationwide, this was the best that RW was going to let us have on a national level, IMHO.