Health care law works in some ways, comes up short in others
Ryan pulled the "repeal and replace" bill drafted by House Republican leaders and blessed by President
Trump blamed
While some parts of the law have obvious problems, others are working well and have brought the country's rate of uninsured people to a record low.
The ACA has added coverage in two main ways: a
But premiums and other costs are rising faster than expected, and insurers have pulled out of markets in many areas, reducing options for consumers.
A status check on the ACA's major elements, and the outlook for each:
Status: Thirty-one states have expanded
Outlook: The
Overhaul efforts will continue, but state governors will take the lead. Expect the federal
INDIVIDUAL HEALTH INSURANCE
Status: The health law was meant to expand and stabilize the market for individual health insurance, through which roughly 20 million people get coverage. It's been a roller-coaster ride instead. As sicker, costlier customers came into the market, premiums and deductibles shot up. Consumers eligible for the law's income-related subsidies were cushioned, but millions who still pay their own way are in shock. Former President
Outlook: Unclear, with analysts offering different opinions. The "glass-half-full" view is that this year's premium increases will help stabilize the market, and 2018 probably won't bring another wild ride. The "glass-half-empty" view is that the markets continue to struggle to attract young, healthy customers, and that's going to keep pushing premiums higher, making coverage unattractive.
In the mix is a political wild card. The Trump administration will have to decide whether to continue paying billions in cost-sharing subsidies that help reduce deductibles for more than half of the consumers using markets like HealthCare.gov. The GOP House has challenged the subsidies in court. Insurers say the system would be unworkable without the money.
Finally, no one seems to have an answer for the problems of people who pay the full cost of their individually purchased health insurance policies. They get no help from the government to shield them from rising premiums. And they complain of fewer available low-premium options as a consequence of federal regulation.
Consumers using HealthCare.gov have also found they have fewer choices as some insurers exited the markets. About one-third of counties currently have just one marketplace insurer.
COVERAGE PENALTY
Status: As a way to get healthy people into the insurance pool, the ACA imposes tax penalties on uninsured people deemed able to afford coverage. Last year 6.5 million people paid penalties averaging
Outlook: The penalty remains the law of the land, but the Trump administration isn't likely to make enforcement a priority.
OLDER ADULTS
Status: Obama's law limited what insurers could charge their oldest, pre-
Outlook: That limitation remains in place for now. Congressional
ESSENTIAL HEALTH BENEFITS
Status: The ACA requires insurers to cover "essential benefits," including outpatient care, emergency services, hospitalization, pregnancy, maternity and newborn care, mental health and substance abuse treatment, prescription drugs, rehabilitation, laboratory and diagnostic tests, preventive and wellness services, and pediatric care, including dental and vision services for kids.
The benefits are considered especially important for women, since birth control and other routine services are now covered as preventive care, at no charge.
Outlook: The ACA's benefits requirement remains in place.
This story has been corrected to show that consumers have reduced options, not that some consumers have no health care options.
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