The Congressional Budget Office (CBO) on Tuesday released its first full analysis of the Affordable Care Act (ACA) since the law’s health-insurance marketplaces opened last October, and, no, it doesn’t show that Obamacare is failing.
First, the bad news. The CBO figures that by 2024 a combination of ACA-related factors will discourage the equivalent of 2.5 million full-time laborers from working. Workers will limit their hours to stay eligible for government health-care subsidies. Employers who have to pay penalties for declining to offer insurance will restrain paychecks, making it easier for people to decide to stay home. The cumulative effect is slightly slower economic growth over the next decade. This trend is not good, but it’s far from the highest hurdle the economy faces. It’s also not a matter of millions getting fired: “The estimated reduction stems almost entirely from a net decline in the amount of labor that workers choose to supply, rather than from a net drop in businesses’ demand for labor.”
But the ACA is not about maximizing economic growth; it is about maximizing a different factor in human welfare: the health-care coverage rate. Making health insurance more available without more ambitious reform involves offering subsidies to enable low- and middle-income Americans to buy coverage. The tradeoff is that some people will choose to work less to stay eligible for those subsidies.
Here’s the good news. Some have claimed the law is in the process of failing at its primary mission, greatly expanding coverage. The CBO doesn’t see any evidence for this claim. True, the Obama administration’s latest figures put the government less than halfway to the CBO’s previous estimate for 2014 enrollment — 7 million people buying coverage in new health-care exchanges. But enrollment should shoot up as a March 31 coverage deadline approaches. Year-one enrollment will be 6 million people, the CBO now figures. After that, the analysts estimate,“enrollment in exchanges will rise sharply in the next few years — reaching 22 million by 2016 — as people become more familiar with the new insurance options and subsidies.”
In years two, three, four and on, in fact, the CBO’s enrollment projections are the same as they were last May. “Starting in 2017, between 24 million and 25 million people are expected to obtain coverage each year through the exchanges, and roughly 80 percent of those enrollees are expected to receive subsidies for purchasing that insurance.”
The ACA has had a troubled early life, mainly because of the Obama administration’s incompetent management of the HealthCare.gov rollout. But the CBO’s report shows that there just is no real evidence that the fundamental policy is doomed.
Update, 11:43 a.m.: Small edits made in the text for clarity.