Survived but still bleeding! #ACA #Obamacare

Without starting a partisan debate, I will take a shot at answering 'So, will Obamacare survive?'. Aside from the perennial grouse of Republicans wanting to tear the legacy of the Democrats, Republicans have opposed two things from the very beginning : 'individual mandate' - making insurance purchase mandatory and expanded federal funding in form of subsidies, expanded Medicaid and payment to Insurance companies to manage the market uncertainties

Truly, these two were the essential pillars in the huge 2300-page bill passed in 2010. The simple premise is that expand the risk pool with healthier population (individual mandate) and fill in the gaps through Medicaid expansion. Minor tremors in form of nearly 50 legislative attempts to repeal were neutralized by the Presidential Veto during Obama Era. Over the last 9 months of the Trump administration, 5 serious attempts have been made namely - AHCA / Trumpcare (March 2017) Better Care Reconciliation Act (June 2017), Partial Repeal, Healthcare Freedom Act / Skinny Repeal (July 2017), Graham-Cassidy (Sep 2017). As the GOP has officially abandoned any more life attempts on Obamacare, before you rejoice, consider how these efforts and sly actions have debilitated Obamacare and its effectiveness to facilitate delivery of healthcare to the American population.

 Things that have been changed that could increase the premium, decrease coverage and in several places give no options to people to buy insurance.

1. Not enforcing Individual Mandate - will encourage more and more people avoid buying insurance and a basic knowledge of underwriting can tell you, premiums will go up due to adverse selection. The executive order stands while ambiguity exists.
2. Weakening Medicaid - eased up several controls on the state to decide who gets and how much Medicaid essentially increased barriers to access Medicaid. e.g. imposing work restrictions
3. Advertisement Budget - It needed educating and promoting the subsidized plans for people who haven't had healthcare in their entire lifetime, to buy a plan and on time. This budget has been reduced by 90% and part of it was used to make ads against Obamacare. #RIP 'in person assisters'
4. Weak Health coverage - Essential Health Benefits set the regulatory standard of minimum coverage that has to be provided by any health plan in the US. In the guise of 'more choices ' CMS has conveniently lowered the standard set by this regulation. Sadly, could make way for the sequel of 'The Rainmaker'
5. Defaulting / Delaying 'Risk Corridor' payments - A small incentive for insurance companies to partake the 'risk' of enrolling patients without underwriting, was the 'Risk Corridor' payments which were paid out by the Federal Govt. All challenges by the current administration to stop these payments have been defeated by the judiciary but the uncertainty around this has been priced in by the Insurance companies for 2018 plans (read: premium increase)

 All these will play out in the marketplace in 2018 and beyond in form of decreased enrollment, increased premiums which again will fuel more defaults in enrollment - a death spiral!

Obamacare is not dead, but it is being systematically sickened! As a compulsive optimist, I hope some of the market behavior - transparency, outcome measurement, marketplace, bundled payments etc - that ACA has unleashed will eventually save the day!