Saturday, July 12, 2014

ACA and the Uninsured Rate

There's a lot of to do about the evidence that ACA has reduced the uninsured rate. They're right. I'm not fan of the law, but, from the beginning, I have believed that the ACA would be able to do one specific thing: reduce the share of people in the category "uninsured".

I also think there will be more uninsured than most ACA supporters claimed would be, but there should still be a significant reduction. Indeed, there already has been according to a number of measures.

Is this not a vindication of the ACA?

In my view, the answer is no. For one, being "insured" is not the same as having access to quality health care. I wrote a post a while back noting how public health coverage often doesn't offer the same quality as private health coverage.

Given that the Medicaid expansion is a big part of the fall in the uninsured and given that Medicaid patients receive worse access and lower quality than patients with private care, the fall in the uninsured may not mean as large an increase in health care access as one might believe. Given the changing nature of private insurance, it's possible that even the private coverage purchased on the exchange may offer worse access than pre ACA private insurance.

As I've said before, the major problems in the health care system are overregulation on the supply side and third party (and employer) dominance in the way we pay for it. ACA doesn't do anything to deregulate the supply side and actually worsens the third party dominance in payment.

The high uninsured rate was merely a symptom of these problems. Covering up the symptom by changing people's insurance status may make our system look statistically better, but it may not offer any real improvements in our health care system.
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