Is the ACA actually 'exploding'? What's working and what's not

President Donald Trump on March 24 scrapped the Republican American Health Care Act because there weren't enough votes in the House to pass it. Despite Republicans' stymied attempt to make good on their vow to repeal the ACA, the president said the health reform law will unravel anyway — on its own.

"The best thing we can do, politically speaking, is let Obamacare explode," he said in the Oval Office after pulling the AHCA from the House, according to NPR. "It's exploding right now."

President Trump used the same rhetoric on Twitter. On Saturday he tweeted, "ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE. Do not worry!"

Even supporters of the ACA usually agree the law is not perfect, but is it actually exploding?

Here is a run-down on what parts of the ACA are working and what parts aren't, according to NPR.

What's working

1. The exchanges are stable. In its assessment of the AHCA, the nonpartisan Congressional Budget Office last week wrote, "The nongroup market would probably be stable in most areas under either current law or the [Republican] legislation," according to the report.

The CBO cited two reasons for this prediction. First, the individual mandate helps stabilize the customer base by incentivizing people to purchase plans on the exchanges. Second, and more importantly, according to NPR, is that most of the people who purchase health plans through the marketplaces get financial help from the federal government to cover their premiums. The premium tax credits they receive rise when premiums rise, so those people are likely to continue utilizing the marketplaces.

2. Many people don't feel the effects of premium hikes. Although it's true that premiums have risen substantially in some states' exchanges, PolitiFact found last week that "most people purchasing healthcare through the marketplace didn't feel it," according to the report. CMS data cited by PolitiFact found that of the 12.2 million people who signed up for health insurance through the exchanges in 2017, 7.8 million, or 64 percent, qualified for tax credits to reduce their individual financial responsibility. Because of those tax credits, the average monthly premium stayed at $106 from 2016 to 2017.

3. The uninsured rate has declined significantly. Before the implementation of the ACA, more than 16 percent of Americans were uninsured. The uninsured rate has fallen steadily since 2013, when the law came into effect, and fell to 8.9 percent, its lowest point yet, in the first half of 2016, according to the report.

4. Although premiums are going up, the rate of increase is slower. NPR qualifies this point as "not exactly great, but it's an improvement." While premiums continue to rise for enrollees in employer-sponsored plans, that growth is slower than it was prior to the adoption of the ACA. According to a study published in the NEJM, premium growth on the exchanges each year from 2008 to 2010 was 9.9 percent, 10.8 percent and 11.7 percent. In 2015 premiums actually decreased by 0.3 percent in benchmark silver plans. Premiums rose again in 2016, but by 3.6 percent. "In other words, premium growth is a seemingly intrinsic part of the U.S. health care system, and growth rates in the ACA's exchange premiums have, if anything, been slower than historical rates," the article states.

What's not working

1. Fewer choices in coverage. As more payers have pulled out of the exchanges, Americans are left with fewer options for health insurance. In some parts of the country, enrollees in the insurance exchanges only have one option, according to the report. A November analysis from the Kaiser Family Foundation found that Alabama, Alaska, Oklahoma, South Carolina and Wyoming had only one insurance company on its ACA exchanges, NPR reported. Additionally, the share of the population that had three or more insurance carriers to choose from fell from 85 percent in 2016 to 57 percent in 2017, according to the report.

2. Hefty premium increases for some. Although about 64 percent of Americans' out-of-pocket spending on premiums didn't rise between 2016 and 2017, according to PolitiFact, premiums rose sharply for about one-third of Americans. Premium hikes were steep in some states, such as Arizona, where average premiums more than doubled, according to NPR. And for individuals who were protected from rising premiums by federal tax credits, the government was responsible for covering the difference.

3. Rising deductibles are making healthcare more expensive. In addition to rising premiums, deductibles and co-payments have also been increasing. According to Kaiser Family Foundation data cited by NPR, the average deductible for individuals who have employer-sponsored health plans was $1,478 in 2016, up 49 percent from five years prior.   

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