The Obamacare Exchanges Don’t Suck

Atrios channels a common liberal complaint about Obamacare:

I was too pessimistic about Obamacare. The Medicaid expansion — despite Roberts and the evil Republican governors — was very good. The insurance regulations that applied across the board (coverage, pre-existing conditions, etc.) were very good. The exchanges still suck — private insurance is very expensive and not so fun to have and the subsidies are not generous enough and the magic competition doesn’t exist and poor people really wish they were just a bit more poor so they could get that sweet sweet medicaid — but for many people barely affordable shitty insurance is preferable to no insurance at all.

I don’t want to pretend that the exchanges are wonderful. They started off with a crash (remember that?). The subsidies fade out at too low an income. In some areas there aren’t many providers. The website can be difficult to navigate. The low metal levels have deductibles and copays that are too high.

And yet, this still deserves some pushback: Exchanges account for half of Obamacare. Roughly speaking, Medicaid expansion covers about 10 million people and the exchanges cover about 10 million people. At low incomes, the cost of insurance is extremely modest. For the poor, silver plans with CSR subsidies cover about 90 percent of medical expenses, which makes them more generous than most of the single-payer systems we admire so much in the rest of the world. The average subsidized cost of insurance on the exchanges is probably similar to what people in other countries pay in taxes for their universal systems, and the income limits on premiums prevent most people from suffering sticker shock when insurance carriers raise prices. Navigators help people choose the best coverage in their region.

Is it perfect? Nope. Does it suck? Nope. Overall, it’s pretty good. Sure, I’d prefer something simpler, but given the realities of the American health care system, private insurance is what we have to work with. If politics is the art of the possible, Obamacare does a pretty damn good job of delivering what’s possible.

Unfortunately, it turns out there is one fatal problem with the exchanges: they can be sabotaged pretty easily by Republicans. Doing this is so unnecessarily cruel to the poor and working class that I can hardly blame Democrats for not foreseeing this problem, but there you have it. Sabotaging Medicaid is hard, but sabotaging the exchanges is easy. And Republicans have given every indication that this is exactly what they plan to do. Their bitterness over a successful law that helps 20 million people is seemingly without bounds.