A critique of the Affordable Care Act

The Galen Institute -- a healthcare free-market "public policy research organization" -- published a study that critiqued the Affordable Care Act (ACA) premium subsidies included in the most recent COVID relief legislation. Among other issues, the author criticizes the legislation for benefiting some higher-income workers more than some lower-income workers. It's possible that there are some nuances about how insurance subsidies work that are not covered, or that legislators simply did not have enough time to work out details. What was interesting was the author's more general critique of ACA: that the CBO estimated that 25 million people would enroll in the health insurance exchanges, but that number is closer to 10 million in reality. ("Annualized exchange enrollment in 2019 was 10 million -- 15 million people below CBO's projections of 25 million exchange enrollees in 2019.") Additionally, the author claims that while 2 million of those 10 million enrollees are enrollees in a private health plan (e.g. non-Medicaid), the number of employees covered by employer-sponsored dropped by the same number, meaning that most of the gains in covered lives came through Medicaid expansion.

The author also pointed out that tax payers are subsidizing insurance premiums by about $50 billion per year and that individual market premiums doubled between 2013 and 2017. All of these statistics point to a less rosy picture of ACA's success -- it would be interesting to read an ACA's proponent's scholarly take on all of this.