At 10 Years Old, ACA Proves More Resilient Than Anyone Imagined

WASHINGTON - The repeal of an unpopular fine for people without health insurance has had little impact on "Obamacare" sign-ups or premiums, a gap between the real world and legal arguments from conservatives again challenging the Affordable Care Act.

The 10-year-old law has proved more resilient than its creators or detractors imagined, even as the Supreme Court considers whether to take up the latest effort to roll it back.

Opponents argue that the constitutionality of the entire 900-page law hinges on the now-toothless penalty for not having health insurance. Collected as a tax by the IRS, the penalty was intended to enforce the law's "individual mandate" that Americans be insured. A previous Republican-led Congress set the fines to $0, effective last year.

"We've gotten a lot of evidence by now about what the market looks like without a mandate penalty, and on the whole it looks pretty stable, which is surprising because that's not what most people would have expected when the ACA was being written," said Cynthia Cox, who directs research on the health law for the nonpartisan Kaiser Family Foundation.

A Kaiser study released this week found that removal of the penalty pushed premiums up about 5% going into 2019, but the bottom line was a wash because of other factors. Insurers appeared to be making healthy profits.

The penalty was thought to be critical when the law was being written in 2009-2010. The idea was to nudge healthy people to sign up, helping keep premiums in check. But Cox said there's no indication that healthy people have dropped out in droves.

In one telling statistic, the Kaiser study found that average hospital days per 1,000 people enrolled dipped slightly in 2019, even after the penalty was eliminated.

Partial sign-up numbers for 2020 released Wednesday by the government point to stability. Nearly 8.3 million people enrolled in the 38 states served by the federalHealthCare.gov website, down only about 2% from last year. A final count including states that run their own sign-up efforts is expected by the spring.

The insurance mandate was the central issue when the Supreme Court first upheld the health care law in 2012.

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