Whether the Affordable Care Act can attract young, generally healthy people to buy individual health insurance through the new exchanges remains in question. Near universal participation will be paramount to making the health care program work. If large numbers of young to middle-age individuals choose instead to pay a tax penalty rather than buy insurance, higher premiums will result and the ACA will not meet the affordability goal.
On Oct. 1 individuals can start utilizing the exchanges to shop for health insurance. The days leading up to that landmark date have seen much information and many predictions released as to how things will play out, much of it contradictory and weighted by advocacy for or opposition to "Obamacare."
In reality, no one can know for sure what will happen. This is an extremely complex way to achieve universal health coverage for Americans. The obvious alternative, essentially extending a Medicare-type system to all, was politically impossible - universally opposed by Republicans and by many moderate to conservative Democrats.
Instead, the nation got the ACA, intended to utilize the private health insurance market to provide universal coverage by creating competition on the exchanges, with tax credits for individuals to offset the cost. But the approach comes with protections and mandates that raise costs for insurers, who in turn will pass them along through higher premiums. These mandates include no denying no denying coverage to people because of pre-existing conditions, and free preventive services that include annual physicals, HPV DNA testing for women 30 or older, and colorectal screenings.
In a good news/bad news report this week, the U.S. Department of Health and Human Services said that based on its analysis, individual premiums purchased on the exchanges would be on average $768 less per year than the Congressional Budget Office had estimated.
In Connecticut, however, the cost of a medium-range plan will be among the highest in the nation at $436 per month, compared with a national monthly average of $328. That is not surprising, however, given the high cost of health insurance found in the state now, tied to its high income and high cost of living statistics.
To mitigate the cost of premiums, tax credits will be available for individuals earning up to $46,000 annually and for a family of four up to $94,000, with the average credit of $2,700 per family, according to the Kaiser Family Foundation.
However, in a recent Forbes article, Obamacare critic Avik Roy said HHS released selective information. Those 40 and under and healthy will end up paying more for health insurance on the exchanges than they can buy it now, even accounting for tax credits. In 2014 that could lead many to opt to pay the tax penalty - 1 percent of income or $95 per person, whichever is higher - rather than buy insurance.
However things play out, there will need to be adjustments. Simply saying no to Obamacare is not a policy. Adjusting it or displacing it with a plan that meets the goal of making health insurance available to all Americans would be.