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Obamacare’s architects try — and fail — to deflect blame

Paul Ryan Holds 'Enrollment Ceremony' For Bill To Repeal Affordable Care Act
Speaker of the House Paul Ryan signing legislation, in January, to repeal the Affordable Care Act.
Chip Somodevilla/Getty Images

On October 7, Vox’s The Big Idea published two pieces on the future of Obamacare — one that took a pessimistic view (by Republican consultant Avik Roy), and one with a more optimistic perspective (by Bob Kocher and Ezekiel Emanuel, who worked in the Obama White House on health care reform). Below, Roy responds to the article by Kocher and Emanuel.

See Kocher and Emanuel’s response to Roy’s article here.

Bob Kocher and Ezekiel Emanuel argue that it’s "misleading" to raise concerns about the fact that individual market health insurance premiums have nearly doubled under the Affordable Care Act. "Premiums today," they say, "are 20 percent lower than the Congressional Budget Office predicted when the ACA was passed." Their argument is nonsensically out of touch, and it illustrates why the designers of the ACA got so many things wrong.

If a Honda Civic cost $15,000 in 2013 and will cost $30,000 in 2017, thanks to federal regulations imposed by Congress, the average person buying a car isn’t going to be particularly impressed by the argument, "Well, you should feel lucky! The Congressional Budget Office predicted that our regulations would make your car cost even more!"

The unaffordability of exchange-based insurance is the ACA’s most serious problem. As research from Avalere Health has shown, enrollment in ACA-based insurance is alarmingly low among those whose incomes exceed 200 percent of the federal poverty level.

Kocher and Emanuel are also factually wrong to argue that insurers would have done swimmingly in the ACA exchanges if not for Marco Rubio. Insurers were losing money on the exchanges because of the way they were designed and implemented. The Obama administration, in response, attempted to create an extra-legal slush fund to aid insurers, using billions in taxpayer dollars they weren’t authorized by the ACA to use. Sen. Rubio was the first to call attention to this problem, and he put a stop to it.

These observations are not solely my own. In a November 2015 memorandum — made public by WikiLeaks — from Hillary Clinton adviser Chris Jennings to John Podesta, Clinton, and others, Jennings described the exchanges’ "disappointing" enrollment as the result of "lack of affordability," "higher adverse selection than expected," and the fact that "the Administration has indicated that they have neither the funds nor the authority" to cover insurers’ losses.

I appreciate that Kocher and Emanuel, due to their partisan affiliations, can’t acknowledge in public what everybody knows to be true in private. But the rest of us can.

Avik Roy is president of the Foundation for Research on Equal Opportunity (FREOPP), and a former adviser to Marco Rubio, Rick Perry, and Mitt Romney. Follow him on Twitter: @Avik.


The Big Idea is Vox’s home for smart, often scholarly excursions into the most important issues and ideas in politics, science, and culture — typically written by outside contributors. If you have an idea for a piece, pitch us at thebigidea@vox.com.