Changes

Still even more uncertain is the future of the ACA itself. While 2016 Democratic Presidential Nominee Hillary Clinton vows to defend the ACA, strengthen its benefits, and minimize any detrimental effect on small business, [https://www.hillaryclinton.com/issues/health-care/] Republican Candidate Donald Trump vehemently opposes the act, stating that he will request a congressional repeal of the Obamacare on his first day in office. [4https://www.donaldjtrump.com/positions/healthcare-reform]

The CBO and JCT forecasted that repealing the ACA would increase the number of uninsured non-elderly people by about 19 million in 2016 and by roughly 24 million in “all subsequent years through 2025, compared with the number who are projected to be uninsured under the ACA.” This amounts to an average annual increase of approximately 8 million, with coverage purchased individually or obtained through Medicaid falling by between 30 and 32 million. [5https://www.cbo.gov/publication/50252]

In an interview with Bloomberg BNA, ex-CBO chief Douglas Elmendorf ,when asked about repealing the ACA, claimed that “there are no alternatives to the Affordable Care Act that are on the table with independent, reputable estimates of their effects on insurance coverage and the federal budget.” [6http://www.bna.com/excbo-chief-elmendorf-n17179927007/]

One alternative to push back against the trend of rising premiums is to increase competition and choice in the insurance provider market. Premium increases vary between states, but some Americans are witnessing “insurers exit the health exchange marketplace, limiting choice, and as a result, boosting premiums” even more than others, depending on their state of residence. [7http://health.usnews.com/health-news/health-insurance/articles/2016-01-06/aca-changes-more-small-business-owners-to-offer-coverage-face-increased-compliance]The CBO has found that premiums tend to be lower in markets with more insurers, hospitals, and physicians. This might seem obvious as insurers would be forced to lower rates to win over enrollees and remain competitive in a market with more suppliers; coupled with an increase in the supply of physicians and hospitals, insurers could negotiate lower payment rates, and as a result, offer lower premiums! However, while it may seem like obvious economics to increase competition among insurers, the CBO warns that “efforts to reduce increase competition among insurers, like other effort to reduce insurance premiums” might produce “complex effects”, as most insurance, hospital care, and physicians’ services markets are already quite concentrated. [8https://www.cbo.gov/publication/51130]

According to the Centers for Disease Control and Prevention’s National Center for Health Statistics, the proportion of uninsured Americans dropped below ten percent in 2015 for the first time in history. [9http://www.wsj.com/articles/number-of-uninsured-in-u-s-drops-below-10-for-first-time-in-2015-1463501948] While proponents of the Affordable Care Act could argue that this statistic serves as a defense of the act in of itself, its opponents argue that the law explain rising costs in healthcare.