"So far, more than 2 million Americans, many previously uninsured, have enrolled in private health plans, thanks in large part to new federal subsidies for low- and middle-income people to buy coverage. Their difficulties in navigating the system since its rocky launch Oct. 1 have dominated the headlines. A far greater number — about 3.9 million — took steps in October and November to sign up for Medicaid, according to federal figures. That includes people who became eligible for the state-federal program under the expansion as well as those who could have enrolled previously, but for one reason or another did not sign up until now. Although the Medicaid expansion has gotten less attention in recent months, it remains a flash point. The issue has split the nation in half and has become a proxy for the broader debate over the role and responsibilities of government." Washpost
The ACA is a strange beast. People are required under the original law to have health insurance acceptable to the federal government. A failure to do that is supposed to lead to a fine on a rising scale over years. Obama keeps delaying the mandates but the original law is still in effect. People with enough money can simply buy from an insurer. People who can't afford to pay the whole cost of this insurance can search in federal or state run "exchanges" for insurance. A complex formula then decides if they deserve a subsidy from the taxpayer in order to pay for that "private" insurance. If they are qualified they are paid this subsidy both in cash and in tax credits. The tax credit is paid in advance based on estimated income for the coming year. What will happen if income does not meet expectation is unclear to me. Does the government seek to recover the money advanced? There are other formulas in the "exchanges" that calculate whether or not a person has such a low level of income that they qualify for a form of the "dole" called Medicaid. People who so qualify would not normally pay federal or state income tax. Medicaid is essentially a single payer system. It is given gratis to the recipients. Medicare, a health care plan for wealthier, older, people, is not free. Premiums are paid for parts of Medicare. The ACA has made Medicaid available to a large number of people who would not have been qualified before.
A couple of observations:
– It should not be surprising that people who are qualified for private insurance subsidie or Medicaid choose Medicaid. It is free to them however costly it is to the taxpayer.
– This result was easily predictable. This raises a question as to whether or not the expansion of Medicaid was not the real goal of the ACA. The subsidies for private insurance are a huge windfall for the insurers. Was this a price paid in order to make Medicaid expansion politically possible.
– The taxpaying citizenry pay the cost of all this and it will be a high cost, but the biggest "losers" in this deal are people who are not eligible for subsidies or Medicaid because of income that is too high but not high enough to make unsubsidized but required insurance affordable. How many will there be in that group? pl