(City Journal) -- Proponents of the Affordable Care Act (ACA) insist that the law will extend health insurance to millions, expand access to health care, and improve Americans’ overall health. But, as the New York Times recently reported, at least 20 percent of the new enrollees have not paid their premiums. They therefore do not really have insurance. But even for those enrollees paying premiums, having health insurance is not the same thing as getting good health care, or any health care. In fact, it doesn’t matter how many Americans obtain insurance under the ACA. Most will have difficulty finding a physician.
Many Americans could lose their employer-provided insurance if firms decide that paying the ACA penalty—and maybe giving small raises to their employees—is cheaper than offering health insurance as a benefit of employment or reduce workers’ hours (the ACA does not mandate coverage for part-time employees). These newly uninsured workers will either have to enroll in Medicaid, if their income is low enough, or purchase a plan on one of the state and federal insurance exchanges. Those eligible for exchange subsidies may end up better off economically as their premiums will be so low, but both the exchange and Medicaid options are fraught with problems.