NEJM November 30, 2017
Perspective
Most complaints about the Affordable Care Act (ACA) (e.g., high and rising insurance premiums, large deductibles, and insurer exits) relate to nongroup insurance markets. These markets, the ones that were the most dysfunctional before the ACA, provide coverage to just 7% of the nonelderly population (under 65 years of age) and 6% of the full U.S. population. The ACA’s changes to employer-sponsored insurance plans, Medicare, and Medicaid were more limited, and enrollees are generally satisfied with those coverage options. The problems with the nongroup market, though significant, are fixable, and correcting them does not necessitate disruption of coverage for the remaining 94% of the population.
These problems spring from two central sources: initial underfunding of the ACA and consolidated...
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