The debate over the effect the Affordable Care Act will have on individuals and families who buy their own policies has mostly been waged in anecdotes. Supporters of the law point to grateful individuals who were previously unable to get insurance or paid exorbitant premiums but found affordable coverage on the new health insurance exchanges. Critics counter with frustrated people who liked their old policies but will now be forced to buy a more comprehensive policy and pay a higher premium for it.
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As it turns out, there are estimates of how many people might fall into one category or the other. Up to seven million people may be able to get health policies without paying any premium at all. Some four million people may have to pay more for new (and better) policies, not all of whom will necessarily be upset at getting better coverage at a competitive rate.
As Reed Abelson and Katie Thomas reported in The Times last week, three independent estimates by Wall Street analysts found that five million to seven million people will qualify for federal subsidies that will exceed the cost of the cheapest plans for individuals and families on the exchanges. Neither the Obama administration nor the insurance companies, however, are promoting the plans vigorously. They believe that many consumers would be better off paying a bit more for a policy that would cover more of the out-of-pocket costs for a doctor's visit or hospital stay.
In the wake of the federal website problems, there's worry about whether the administration can reach its goal of enrolling seven million uninsured Americans in 2014. Surely the five million to seven million eligible for zero-premium policies would be an easy sell. About half of them are under age 39 and uninsured, the kind of young people the exchanges need to broaden the risk pools. Health officials should pull out all the stops to identify and enroll them.
There is no official estimate of how many higher-income earners who have been buying individual policies would pay more when forced to buy new policies. Jonathan Gruber, a health economist at the Massachusetts Institute of Technology who played a role in shaping the Affordable Care Act, estimates 12 million people are currently covered by policies bought on the individual market. He says that, after factoring in subsidies on the exchanges, perhaps eight million will be covered by less costly policies next year, and four million will be covered by more expensive policies, which often provide richer benefits.
Individuals facing higher premiums are understandably distressed. But there is no getting around the fact that health reform changes the status quo — including requiring insurance companies to provide essential health benefits that were not previously covered and to take on people who were rejected before because of their health.
Those who will pay more should take comfort in the knowledge that should they lose their jobs or face financial hardships or a medical crisis their previous policies would not have adequately covered, they would benefit from a health care safety net that offers federal subsidies and comprehensive coverage.
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