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Monday, October 24, 2016

by Charles Ornstein, ProPublica.

Today marks one month since the disastrous start of, the seriously impaired federal health insurance marketplace.

And what a month it’s been. For the first 16 days, a federal government shutdown largely deflected attention from the website’s problems. But since then, three congressional hearings have been held — and more are planned. Political pundits are anointing winners and losers (mostly losers) and trying to predict how the fallout could affect congressional elections next year.

I’m more interested in real-life winners and losers, people whose lives will be changed for better or worse because of the Affordable Care Act.

Clearly, if the website problems persist for much longer and people are unable to sign up for coverage, the list of losers will grow longer by the week. Consumers will lose because they won’t be able to enroll in health plans. Insurers will lose because they will have far fewer customers than anticipated. Hospitals will lose because the law cuts back their reimbursement for care they give to the uninsured. And on and on.

But for the moment, let’s assume some — or most — of those problems will be fixed by the Nov. 30 date promised by the Obama administration.


On a very obvious level, winners include young adults who can now remain on their parents’ health plans until age 26.

They include consumers with medical ailments who have been denied health insurance because of pre-existing conditions.

They include residents of states that opted to expand their Medicaid programs for the poor to cover those with incomes of up to 138 percent of the federal poverty level ($15,856 for an individual and $32,499 for a family of four).


By contrast, losers include those with lower incomes who live in states that decided not to expand their Medicaid programs. The Daily Briefing run by the consulting firm The Advisory Board Co. had a smart look this summer at which states will have the most uninsured residents in 2016. Being uninsured means you’re losing out.

Also sure losers are undocumented immigrants, who are ineligible for benefits or subsidies under the act.

And for now, at least, small businesses lose out because of the Obama administration’s ongoing delays launching a health insurance marketplace for small businesses. (, by contrast, is an insurance marketplace for individual consumers.)

Too Soon to Say

Another group that many commentators count as losers are the hundreds of thousands of consumers who have received cancellation notices from their individual health insurance companies because their policies don’t meet criteria set forth in the Affordable Care Act.

I hesitate to call all of them losers because some of them will be eligible for subsidies from the federal government to offset the cost of their new health insurance, and others will pay less in the new marketplace for better coverage. To be sure, some people clearly will lose out because they will pay more for their coverage — and their benefits won’t be all that much better to offset it.

What Others Say

The New Yorker’s Ryan Lizza had an interesting piece this week in which he spoke to economist Jon Gruber, who broke down winners and losers this way:

About 80 percent of Americans are more or less left alone by the health care act — largely people who have health insurance through their employers. About 14 percent of Americans are clear winners: they are currently uninsured and will have access to an affordable insurance policy under the ACA.

But much of the current controversy involves the 6 percent of Americans who buy their own health care on the individual market, which the ACA has dramatically reformed. Gruber argued that half of these people (3 percent of all Americans) will have little change to their polices. “They have to buy new plans, but they will be pretty similar to what they had before,” he said. “It will essentially be relabeling.”

The other half, however, also 3 percent of the population, will have to buy a new product that complies with the ACA’s more stringent requirements for individual plans. A significant portion of these roughly nine million Americans will be forced to buy a new insurance policy with higher premiums than they currently pay.

Economist Justin Wolfers tweeted the previous few paragraphs as a chart:

I posed this question to several smart folks I know — journalists, scholars, think-tank folks — and this what they said. Boston University health economist Austin Frakt, who blogs at The Incidental Economist (a must-read), said he breaks down winners and losers into short-term, mid-term and long term.

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  • elw

    I say it is too soon to call winners or losers, only time will be able to show that. I say by this time next year we will know whether or not the ACA is a good thing or a bad thing. The rest of continued predictions and commentary on whether it is working or not is just empty words to fill the 24/7 time slots of the news.

    • Lynda Groom


      • lana ward

        6 people sighed up for it the first day. The 3rd day 200 and some. It is going to fail. It has failed in every country that has tried it—now top hospitals are opting out. OHitlers transformation of America is going to make us a failed country. He isn’t even the most powerful person in the world anymore, Putin is

        • Vinny Gordon

          It is running very well in MA. You are not counting the people who have signed up on the states who started their own exchanges. Time will tell.
          The GOP slogan for 2014 will be:”Vote GOP to end your health care” If 50% of those folks are getting subsidies it will be a hard sell. A lot will be on Medicaid in those red states. It is a losing slogan. That’s why the GOP is so desperate to kill it now.
          The biggest GOP fear is that Republicans are going to like Obama care just like they like Medicare or LBJ care.