Beginning last summer, and continuing unabated until a few weeks ago, conservatives undertook a variety of efforts (both subtle and explicit) to discourage people, particularly young people, from enrolling in ACA-compliant health plans.
The idea was to deny state-based insurance markets critical mass, and sound risk pools, and send them into actuarial death spirals. In almost every instance, conservatives were appealing to strangers to undertake considerable personal risk in service of dubious ideological principles.
Though these efforts failed to achieve the larger goal, they almost certainly succeeded at convincing some people to skip Obamacare. And when confronted about the recklessness of their strategy, the most unscrupulous conservatives would say, No biggie! Obamacare allows people to enroll after they get sick or injured. So there's no risk at all.
This was a lie. And if it weren't such a dangerous lie, I'd be amused to find that conservatives now want you to be outraged about the fact that the Affordable Care Act creates limited open-enrollment periods each year to prohibit precisely that kind of free riding.
There is yet another ObamaCare surprise waiting for consumers: from now until the next open enrollment at the end of this year, most people will simply not be able to buy any health insurance at all, even outside the exchanges.
"It's all closed down. You cannot buy a policy that is a qualified policy for the purpose of the ACA (the Affordable Care Act) until next year on January 1," says John DiVito, president of Flexbenefit which has 2,500 brokers.
John Goodman of the National Center for Policy Analysis in Dallas adds, "People are not going to be able to buy individual and family policies, and that's part of ObamaCare. And what makes it so surprising is the whole point of ObamaCare was to encourage people to get insurance, and now the market has been completely closed down for the next seven months."
That means that with few exceptions, tens of millions of people will be locked out of the health insurance market for the rest of this year.
For those of you just tuning in, an open-enrollment period is
an obscure policy tool one of the most common ways of creating access to health benefits without also creating an incentive for people to pocket their premium dollars until they actually experience medical problems. It is one of the cornerstones of the employer-based insurance system, of Medicare Advantage, and of Medicare's prescription drug benefit. Conservatives are conspicuously silent about those open-enrollment periods.
Goodman's correct to note that time-limited enrollment leave millions locked out of the insurance system each year. But that's not really much different from the old system, which allowed people to apply for insurance whenever they wanted, but discriminated against people who had been uninsured for long stretches of time, and either would deny coverage to individuals who signed up after experiencing catastrophic medical events, or wouldn't cover expenses incurred prior to enrollment.
The end of open-enrollment each year is one of the few sticks in ACA's broader incentive structure. It partly explains the late-March enrollment surge. But the conservatives attacking it now weren't stricken by the epiphany that their recent efforts to discourage enrollment were morally reprehensible. If so, they'd acknowledge that the best way to eliminate open enrollment is to establish a universal benefit, like Medicare-for-all, that covers everyone without insurance automatically. No, now that enrollment is closed, they're clamoring to flood the existing insurance markets with high-cost beneficiaries and send premiums skyward. Failing that, they want the people who didn't enroll—including those who didn't enroll on the advice of ACA opponents—to be angry at Obamacare for leaving them out in the cold. In a more sane country, everyone would be pulling in the same direction, so that the end of open-enrollment didn't leave as many people stuck with nothing for months on end. But we don't live in a country like that. We're stuck with a system in which one of the two major political movements spends the months before open enrollment trying to discourage as many people from signing up as possible, and the months after complaining that all these people don't have access to insurance.
Brian Beutler is a senior editor at The New Republic.