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Hey, ACA flood: Go away

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The Affordable Care Act is unpopular.

The new House Republican ACA de-funding act proposal, the American Health Care Act bill draft, also seems to be unpopular.

Related: GOP ACA change bill may favor commercial health

Thumbtack, a San Francisco-based exchange for professional services, says that 55 percent of the small business owners want Congress to keep the ACA in place, and one-quarter say access to health insurance through the ACA was a factor in their decisions to start their businesses.

Another company, Mountain View, California-based eHealth Inc., the parent of, points out that most people who buy their health coverage think they buy it because they need it, not because of fear of tax penalties. Only 41 percent of the 500 individual health buyers the company surveyed said they thought the Internal Revenue Service would enforce the ACA individual mandate penalty for 2016 returns. Only 7 percent said they would cancel their coverage if the mandate were repealed.

I think the two surveys illustrate an important debate: Market forces have a way of doing what they want to do.

At some point, flood water rises above any mechanisms designed to control it and goes where it wants to go, regardless of how unpopular that flood might be.

The same is true of capital that could go into health insurance, and of people’s demand for health insurance.

Health insurers are meeting with Centers for Medicare & Medicaid Services officials in Washington about the fate of the 2018 individual health market right now. Any for-profit carriers, or carriers that have debt, are facing intense pressure to wash their hands of that market.

Meanwhile, people need some way to pay for health care. If they can’t get it by buying individual major medical coverage, they’ll try to use short-term health coverage, join a health care sharing ministry, or rob a bank.

Republicans in Congress and the Trump administration may have added to the turmoil, but plenty of flood water was already there this past summer, when Hillary Clinton avoided saying much about the ACA or the commercial health insurance market while campaigning for the Democratic nomination for president.

If Clinton were president, she would be dealing with some version of the same upheaval that’s going on now.

If Bernie Sanders were president, he might be using the situation as an opportunity to offer a single-payer health care system proposal, but we’d just see a mirror version of the current attacks on the AHCA bill draft.

Change was coming, and is coming, whether anyone wants change to come or not. The only question is whether change will come through a thoughtful, bipartisan process; through one party bullying the other party and ramming any old legislation through; or through a form of malignant gridlock that causes markets to bulge and pop like a package of spoiled cheese. 


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