In a word: No. Right-wing zealots are cherry-picking a few exceptions where insurance costs have skyrocketed and insurers have pulled out of marketplaces, while the vast majority of markets have had modest insurance cost increases (below historical averages for the previous ten years prior to the Affordable Care Act) and still have meaningful choices in the marketplaces.
That said, we’re starting to see some of the problems that were predicted earlier, and they *will* kill the whole concept behind the ACA if reforms are not made. There are two primary reasons for this:
1. Adverse selection. We are seeing that a large number of companies are *not* providing health insurance for their employees the way the ACA requires, and large number of healthy people are not signing up for ACA policies, waiting until they get sick to do so. The problem is that health care takes up 17% of national GDP, while sick people earn 1% of national GDP. You do the math — 1% of GDP can’t pay for the health care of 17% of GDP! Only if healthy people buy health insurance can it cover the costs of sick people. Otherwise insurance goes into a death spiral, as fewer and fewer buy it.
2. Narrow networks are making “shall issue” into a lie. If the network has poor-quality doctors, only healthy people will sign up for it. This is a way for insurers to slag off expensive patients onto other insurers.
So let’s look at solutions. First, enforcing the mandate. The problem we have there is that the notion of having the IRS start enforcement actions against people who aren’t complying with the mandate is politically unpalatable. Having people’s bank accounts, cars, and other assets seized to fulfill penalties against people not buying healthcare or providing it for their employees has proven to be extremely unpopular to the point of being outlawed as part of the ACA.
Either we do these enforcement acts, though, or the whole system collapses. Or we come up with some other way for getting the money. For example, we could increase the Medicare payroll tax by enough to cover health insurance, then issue vouchers to people that they can trade for the health insurance of their choice. Payroll taxes are enforced pretty well already so the enforcement issue isn’t really a big one there. The big problem there is that the health insurers would have to accept the voucher amount for their “silver” plans, and there’s little chance that they’ll agree to do that, because it gives up their ability to have different prices in different counties.
Then #2. The whole point of the “network” was “managed care”, which was supposed to give patients a seamless experience between their family practitioner and specialists they need, but in practice “managed care” has proved to be where doctors are put into the situation of working for the insurance company rather than working for the patient, denying care in order to avoid being kicked out of the network. We can say that insurers must accept anybody into their network who is willing to accept their reimbursement levels. That’s one way to do it, I suppose.
Or we could do away with all of this and just have Medicare For All funded by the Medicare payroll tax, with traditional health insurers now in the situation of providing MediGap coverage on top of basic Medicare rather than having full responsibility for patient care. At that point we get rid of the problem of enforcement of the mandate, and we get rid of the problem of narrow networks making “shall issue” a lie since Medicare will accept any doctor willing to comply with its regulations. But I suspect things will have to get a *lot* worse before the nation is willing to go to that extreme…
– Badtux the Healthcare Economics Penguin