So far, to date, the Obama administration's state and federal health insurance marketplaces have enrolled 2.1 million people, a much lower number than expected. For those who were against the Affordable Care Act (ACA) in the first place, this has given them more ammunition, but I'd argue that they're missing the point.
Let's say, hypothetically, that the marketplaces go bananas between now and March 31, the end of the open enrollment period for this year's ACA policies. Let's say 10 million people obtain coverage on the exchanges. That's certainly a lot of people, and it's good that they'll be helped by the accessibility of these policies -- though I'd argue that the fact that they come with elephantine deductibles and coinsurance reduces the value tremendously.
All that being said, what happens to those who simply can't afford to enroll? After all, these policies -- at least for my age band -- come in at $300-odd a month per person, give or take. If the consumer can't afford the policies without a subsidy, but can't get a subsidy due their allegedly "high" income, they are left without viable market options. As is nearly always the case, federal policy is pretending that the middle class doesn't exist.
If you look at the numbers, you see that the ACA will barely make a dent in the numbers of working people who don't have health insurance. If you accept as given the widely-bruited figure of 40 million uninsured in the U.S., the 10 million new insureds we're postulating here is good but hardly a broad-based solution to the problem of the uninsured in this country.
You've got a "donut hole" in the people the ACA can work for, but nobody wants to talk about it. I personally contacted three organizations which worked to get the ACA passed. Only one would discuss the problem of the uninsurable middle-class with me, and he did that on background, so I can't tell you who he works for or what he does there.
He told me that such organizations are very aware of the limitations of the ACA, including the reality that many middle-class people can't afford to buy policies on the exchanges. But they don't want to discuss them because they feel this would take attention away from helping those that can be helped by the legislation.
Well, I can see why such organizations would focus on the positive. But readers, know that when uninsured middle-class folks show up in your ED, much sicker than they need to be, it's essentially a part of the design of the legislation. And if that doesn't work for you, financially or ethically, you may want to speak up. Sounds like nobody else is going to.