I’ve recently posted to SSRN a new paper with the same name as this post. The paper asserts, in greater detail, a number of points I’ve previously made on TOTM:
- Health insurance premiums will rise under the (SCOTUS-modified) ACA, because the Act’s “guaranteed issue” and “community rating” mandates will generate widespread adverse selection that cannot be corrected through the (now constitutionally constrained) penalty system the Act imposes.
- Underlying medical costs will continue to outpace inflation because the ACA does nothing to alleviate the primary driver of health inflation: the lack of price competition among providers, an artifact of the federal tax code’s encouragement of overly generous health insurance policies that ultimately amount to “pre-paid health care.”
- Insurance coverage will expand far less than ACA proponents promisedbecause (1) the Act encourages employers to drop insurance coverage for lower-income workers, and (2) SCOTUS has largely disabled the Act’s Medicaid expansion.
I’ve been talking about these matters quite a bit lately. On Constitution Day, I participated in this discussion of the ACA with my Missouri colleagues Phil Peters (a health law expert), Josh Hawley (a constitutional scholar and former Roberts clerk), and Stan Hudson (associate director of MU’s Center for Health Policy). (My remarks begin at 23:45.) On September 25, I presented a lecture on the ACA at my undergraduate Alma Mater, Wheaton College. My PowerPoint presentation is not visible in the Wheaton video, but I’m happy to share it with anyone who’s interested. Just email me at lambertt at missouri dot edu.