We now have some more good news about the implementation of the Affordable Care Act, and it’s good news of a type that ought to warm the hearts of the law’s conservative critics.
There have been some developments that conservatives can lament, even as the rest of us find them cause for celebration. Some would say that the fact that eight million additional Americans have been enrolled in Medicaid because of the law is an unalloyed good, but many conservatives would think the opposite, because those people are now suckling at government’s teat.
But what about when the free market embraces Obamacare? What’s a conservative to think then?
That’s what new numbers released by the Department of Health and Human Services show. The new data reveals that the number of insurers offering coverage through the exchanges is set to increase by 25 percent next year. In some states, the number of participating insurers will double. For every insurer that has dropped out, five more have joined.
In other words, insurance companies are lining up to participate in the exchanges. This increased competition should help keep premium hikes down, since as any free marketeer will tell you, that’s what competition does.
The law’s opponents, of course, predicted that the exchanges wouldn’t be attractive to insurers, partly because of a lack of young people signing up for insurance. Left with a bunch of old, sick people whom they couldn’t insure profitably, the insurers would avoid the exchanges like Ebola. This lack of competition would lead to enormous premium increases, as the few remaining insurers jacked up charges to avoid losing money. Presto: the Death Spiral!
But the opposite happened. As the insurers’ behavior makes clear, it isn’t just that the exchanges have not become ground zero for a death spiral. It’s also that the exchanges are a place where there’s money to be made, even as premium increases have slowed. The market is working, and those most noble actors pursuing that most noble goal — private corporations seeking profit — are responding.
In a rational world, conservatives would say, “Well, I don’t like all that increased regulation and expansion of Medicaid, but this does demonstrate one good thing about the law. I guess it’s a complicated story.” But of course that’s not what they’ll say.
It feels a little odd for someone like me to be begging conservatives to heed the wisdom of the market. It’s the big-government provisions of the ACA that I’ve been most enthusiastic about, like the expansion of Medicaid (which got relatively little attention when the law was moving through Congress, despite having the largest impact on the most people). I favored the inclusion of a public option. I’ve argued that the problems the law has encountered come in large part because it tried so hard to maintain the private, profit-driven nature of American health care, layering a new set of rules and processes on top of an already impossibly complex system. I still harbor the hope that one day we might achieve single-payer health care, or perhaps a hybrid system like France’s that achieves the goals of both public and private.
But once the decision was made to channel so much of the Affordable Care Act’s changes through the private system, we should all be able to agree that we want the market to work as well as possible. So c’mon, conservatives — look to your free market principles, and give Obamacare at least a little credit.