Obamacare update

So where do we stand with Obamacare, now that HealthCare.gov is more or less working?  Michael Gerson reports:

The early returns are in. A large majority of the 2.2 million people who had purchased insurance on the exchanges by year-end — 65 percent to 90 percent, according to reporting by the Wall Street Journal — already had insurance. Economic writer Megan McArdle did the math, estimating that just 15 percent (750,000) of the 5 million uninsured that the Congressional Budget Office expected to sign up in the first year have actually done so. Meanwhile, administration claims about increases in coverage for the uninsured under Medicaid are badly, even deceptively, inflated, as Sean Trende has documented.

Economists debate the reasons for this failure of uptake. But, as it stands, Obamacare is largely a health insurance replacement system rather than an expansion. And the replacement is often less generous, more expensive and more restricted in options than promised. Yet, as McArdle pointed out, “the worst is yet to come”: small-business policy cancellations, expensive government subsidies to insurance companies for excess losses, higher premiums in the exchanges, the IRS collection of individual mandate penalties, cuts in Medicare Advantage, the “Cadillac tax” on expensive policies, the possibility that some insurers will exit the public market entirely.

This year’s problems and uproars will be nothing compared to next year’s, when employer-provided insurance is affected and all of the sanctions mentioned here click in.