Obamacare Is Doing Well, But Trump and Ryan Can Change That If They Want


Today brings a couple of pieces of tentative good news for Obamacare. First there’s this:

The Trump administration says it is willing to continue paying subsidies to health insurance companies under the Affordable Care Act even though House Republicans say the payments are illegal because Congress never authorized them….The Affordable Care Act requires insurers to reduce deductibles and other out-of-pocket costs for certain low-income consumers. The “cost-sharing” subsidies, which total $7 billion a year, compensate insurers for these discounts.

….House Republicans sued the Obama administration, saying that the spending — in the absence of an appropriations law — was unconstitutional. A Federal District Court judge agreed and ordered a halt to the payments, but suspended her order to allow the government to appeal.

This is a huge deal. CSR payments are critical for insurance companies, and the Trump administration could have decided to stop defending the law and let House Republicans kill the payments by default. That could still happen, but it sounds like it won’t happen this year, at least. This was the single biggest bit of uncertainty facing insurance companies this year, and this announcement should ease a lot of their short-term concerns.

So with this temporarily out of the way, how does the overall Obamacare market look? According to Standard & Poors, profit levels for insurers are still too low, but they’re improving and the market seems to be in pretty good shape:

The U.S. ACA individual market shows signs of improvement, as most insurers’ 2016 results were better than 2015 results….2016 results and the market enrollment so far in 2017 show that the ACA individual market is not in a “death spiral.”

….We believe the continued pricing correction and network design changes, along with regulatory fine-tuning of ACA rules, will result in closer to break-even underwriting results, on average, for the individual market this year….As insurers continue to adjust their products and pricing, we expect some premium rate increase in 2018 as well. If it remains business as usual, we expect 2018 premiums to increase at a far lower clip than in 2017.

S&P’s biggest worry is Congress futzing around with things: “Every time something new (and potentially disruptive) is thrown into the works, it impedes the individual market’s path to stability.”

Two things are pretty clear. First, contrary to what folks like Donald Trump and Paul Ryan say, the Obamacare market is not on the verge of collapse. It’s working pretty well and is likely to get better in the future. But second, Trump and Ryan certainly have the power to put Obamacare on the verge of collapse if that’s what they want to do. Now we just have to wait to find out what they want to do.