From "It'll Destroy America!!" to "It Doesn't Suck But It Will Someday!" in 10 Easy Steps

  • 1. October 2013: "No one can enroll!!"

(ok, this one is a gimme; the technical mess at and some of the state exchanges did make it almost impossible for anyone to sign up the first month.)

  • 2. November 2013: "No one will enroll!!"

...which was clearly already being proven wrong by the time Thanksgiving rolled around.

  • 3. December 2013: "Hah! They'll never break a million!!"

...that is, until the Christmas/New Years spike, which brought the total enrollee figure up to over 2.1 million.


...which actually turned out to be only around 1-2 million people at most, the vast majority of which (including myself) simply swapped out their old policies for new ones.

  • 5. February 2014: "Well...there's no way they're gonna hit the 7 million mark!!"

...except that by the end of February the total had hit 4.2 million. The final total, of course, would prove to be 8.02 million by 4/19 (and around 9.2 million by Labor Day)

  • 6. March 2014: "But...but how many of them have paid??"

...well, this seemed a wee bit early to be asking that question considering that the policies for over 52% of the eventual enrollees wouldn't even take effect until April or May, but in the end the answer turned out to be around 90%.

  • 7. April 2014: "OK...But how many of them were already insured??"

...around 43%, as it would eventually turn out, which is even lower than the 50% I had estimated.

  • 8. May/June 2014: "Rate Shock!! Premiums will shoot through the roof in the 2nd year!!", actually. More like 7% on average, give or take...which is actually lower than the 10-11% per year that came before the ACA.

  • 9. July/August 2014: "ATTRITION!! People are fleeing Obamacare by the millions!!"

Um...not so much; more like 3% per month, give or take, which is natural, expected, after being partially balanced out by off-season enrollments.

...which brings us to September, and Avik Roy's latest talking point, which boils down to:

  • 10. "OK, it's not a disaster, but it will be in the future!"

His premise boils down to two main points:

First, he claims that the ACA has already casued a "rate increase of 49%", which I've already demonstrated is hogwash (to reach that conclusion, the study he cites compares "discount cards", which amount to coupon subscriptions and which don't include actual hospitalization coverage, etc. against actual healthcare insurance policies by any reasonable definition of the term).

Second (and this one may have some merit in the future), is that the risk adjustment/reinsurance/risk corridor provisions in the ACA (which ironically amount to insurance policies for the insurance companies) will be running out at the end of 2016 (emphasis mine):

Importantly, a set of Obamacare exchange provisions called the “three Rs”—risk adjustment, reinsurance, and risk corridors—effectively encourage insurers to offer premiums on the exchanges that are imprudently low. If you are an insurance company, and you lose money because your premiums were lower than your actual claim costs, Obamacare subsidizes that loss for you. It’s this part of the law that Sen. Marco Rubio (R., Fla.) and others have been calling a “bailout” of participating insurers.

The problem is that the “three Rs” are transitional. Reinsurance and risk corridors expire at the end of 2016, at which point insurance companies like Aetna, Humana, and Cigna will have to charge premiums in line with their costs. That may lead to a spike in premiums in 2017.

First, I do give some credit to Mr. Roy for actually using the terms "ACA" and "Affordable Care Act" in his latest missive, if only once each (and in one case putting sarcastic "air quotes" around the term). This makes his latest ratio 18 "Obamacares" to 2 "ACA/Affordable Care Acts", a distinct improvement over his prior 25 "Obamacares" to 0 "ACA/Affordable Care Acts". So, you know, kudos for that.

Of course, there's a rather obvious reason for his insistance on using the "O" term so much.

On the other hand, that's an awfully big "may".

Maybe he'll prove to be correct. Maybe premiums will shoot through the roof in 2017.

However, there's about 100 other things which may happen between now and then as well. Maybe the new Apple Watch will help usher in a new age of personalized healthcare monitoring which will lower costs. Maybe the other 20-odd red states which have refused to expand Medicaid will finally stop being jerks about it (as Pennsylvania, Utah, Tennessee and even Wyoming appear to be on the brink of doing). Maybe the cost of Medicare will continue to drop for whatever inexplicable reasons you care to cite.

Even if Roy proves to be correct on this, it doesn't change the fact that opponents of the Affordable Care Act have been forced to change their tune from "Obamacare will turn America into a post-apocalyptic wasteland!!" to "Well...ok, maybe it won't, but that doesn't make it awesome, and it'll probably suck in a few years."