Three years ago this week,
ObamaCare was signed into law. The president’s health care overhaul
has already had a rough life. Since passage, it’s survived a
Supreme Court challenge, more than two dozen repeal votes in
Congress, and host of implementation hurdles and political
controversies. And that’s just the beginning: The law’s major
coverage provisions — a Medicaid expansion and private health
insurance subsidies administered through state-based health
exchanges — won’t kick in until later this year. ;
With that in mind, here’s a three-year check-up on the law —
where it stands, and what it faces going forward.
Premiums are already going up. States such as
Florida, Ohio, and California have already seen insurers request
double digit rate hikes. ObamaCare’s insurance mandates have
contributed to the rise, and the law’s requirement that insurers
spend 80 percent of premium revenue on health care or rebate the
difference to customers — the so-called 80/20 rule —
creates further incentives for insurers to charge high up front
Insurers are warning of even bigger premium hikes when
the law’s major provisions kick in next year. Privately,
other insurers have issued similar warnings of large rate hikes on
the way. Aetna CEO Mark Bertolinin
told the company’s investors last December that some
individuals could see hikes of up to 100 percent. Privately,
insurers are also warning brokers are large rate hikes to come.
Even state insurance officials in ObamaCare-friendly states have
cautioned that “rate and market disruption” is on the way.
The public still doesn’t support the law. The
law has always struggled in the court of public opinion, and
there’s little reason to believe that that’s about to change. After
a brief jump in public approval coinciding with last year’s
election, public opinion regarding the law has started to sink once
again. The law has even lost favor amongst voters in the
president’s own party in recent months, with a recent Kaiser
showing Democratic support for the law dropping from 72 percent
in November 2012 to 57 percent in February of this year.
The law is still the subject of heated political
controversy. Given the continued lack of public support,
it’s hardly surprising that legislators would oppose the law as
well. But that’s had big consequences for ObamaCare, which was
expected to rely heavily on states for implementation. Instead,
more than half of the states have exercised their right to opt out
of the exchange-creation process, letting the federal government do
it instead. Additionally, a number of states have announced that
they won’t pursue the law’s Medicaid expansion either.
There are more legal challenges in the works.
The text of the law says unambiguously that only only exchanges run
by states shall be allowed to administer the law’s insurance
subsidies, and that only employers in those states shall be subject
to its employer fines. But the Internal Revenue Service
decided to ignore the clear text of the law; its regulations
say that employers are subject to fines even in states with
federally run exchanges, and that the subsidies are available in
those exchanges too. Oklahoma’s attorney general has
already filed suit against the rule.