The architects of the Affordable Care Act, like everybody who understands health policy, knew this would happen. And they crafted the law in a way that would cushion the impact for most people. The most obvious method is those subsidies, which offset higher premiums in part or in whole for the majority of people buying coverage on the new exchanges. The law has other, less well-known provisions to help restrain insurance prices—most notable among them, a “medical-loss ratio” requirement that effectively limits how much profits insurers can make. These steps will reduce the number of people unable to find better coverage or facing the prospect of actual “rate shock.” But these steps won’t help everybody. Some people will end up with worse options.
You probably want to know how many people fall into this category. I do too! It’s impossible to be certain. The data on people buying their own insurance is incomplete, ambiguous, and conflicting. But most experts I’ve consulted believe that, of the small percentage of Americans who buy their own coverage, a minority should end up paying more next year. (For an alternative view, read Avik Roy of the Manhattan Institute.) The ones facing the most severe sticker shock will tend to be more affluent, since they will get little or no help from federal subsidies.
Of course, these people may not feel affluent. That’s particularly true if they live in an area where real estate, gasoline, and other routine costs make it expensive to live. The suburbs of Washington, D.C., where Laszewski lives, is one such place. San Francisco, where Hammock and Brothers live, is another. For a couple in either city making $70,000 or $80,000, which is just above the subsidy threshold, absorbing a few thousand dollars a year in extra health insurance premiums will probably seem like a big deal.