What If They Gave an Exchange and Nobody Came?

With almost one in five of its residents lacking health insurance, officials in Palm Beach County thought they had hit on a smart solution. The county launched a program that offered subsidized coverage to residents who couldn’t afford private insurance, but made too much to qualify for Medicaid, the state-federal program for the poor. Enrollees would be able to buy policies for about $52 a month — far cheaper than what private insurers were offering. But a year after the program began, fewer than 500 people had signed up — less than a third of the number expected.

More examples from Kaiser Health News.

Comments (12)

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  1. Patel says:

    If they are going to make the process of qualifying for the service too much work, then most people who don’t have pressing health challenges will not put in the extra time to go through the process. Thus, I think this might be a reality in certain counties.

  2. Sandeep says:

    I think Patel has made a very insightful observation.

  3. Kumar says:

    I think that most people will sign up to insurance willingly. Given the amount of attention this has garnered, I have no doubt that people will pay attention to the process of how to gain access to ObamaCare.

  4. Jardinero1 says:

    It is an actuarial fact that more than three fourths of all health insureds pay more for insurance than they receive in reimbursements. Most people, especially, younger people, and people without much money, understand this intuitively. That is why up most people, given a choice, will not spend any amount of money on health insurance.

    Given that, I predict that few will take advantage of the exchanges. I predict that very few will obtain the subsidies to buy on the exchanges. I predict that the federal government will reap a huge windfall on the employer and individual penalties.

  5. Sadat says:

    I think there may be small pockets where this will be the case, however, I am inclined to expect most people, slowly but surely, enroll into this system over time. I just have a hunch, given how human nature tends to work that people will enroll into the system over time.

  6. Linda Gorman says:

    Old news. There’s an report from Wisconsin’s Badger Care years ago that laments the fact that low income people won’t sign up for coverage if any premium is charged.

    This is rational behavior. If you have a low income and no assets you don’t need insurance. If you can’t work, you become eligible for Medicaid. For other things, there are free clinics and charities.

    Which is why there won’t be complete coverage unless and until we have single payer care and why the left constantly emphasizes coverage as the goal rather than medical care.

  7. Myriam says:

    Linda, for other things, there are free clinics and charities? What things and which free clinics and charities? I’d like to know.

  8. Ryan Hall says:

    I also think that most people will eventually buy into the system.

  9. Linda Gorman says:

    @myriam–for starters, there are the Federally Qualified Health Clinics. Primary care is free or on a sliding scale relative to income, capping out at about the price of a family meal at McDonald’s. Free vaccines for kids, too.

  10. Bob Hertz says:

    I believe that most Canadian provinces have a requirement that each citizen pay a nominal amount ($50-$100) a month toward their national health insurance.

    And about 5% do not pay, although they still are covered.

    Here in America, we have more or less required hospitals to act as public emergency institutions — but then we want to persuade, subsidize, and/or mandate that people buy health insurance to pay the hospital.

    It would be better to have a small tax to pay for emergency services, not unlike how we pay for fire and police.

    Is this a form of coercion? Of course. We should admit that a modern high-tech health system will require some level of financial coercion. We can coerce everyone to pay a tax, or we can coerce actual patients to pay enormous hospital bills. I vote for the tax, at least when it comes to emergency care.

    As I have noted before, Avik Roy endorsed a plan like this last year, as described in an Atlantic Monthly piece on free market health care.

    Bob Hertz, The Health Care Crusade

  11. Gabriel Odom says:

    The fact is, people like me (young, healthy, single) place very little value on health insurance. I rarely get sick, and clinics aren’t that expensive. Why should I spend thousands on health insurance? I won’t, unless the government makes me.

  12. Bob Hertz says:

    To Mr Odom — the thousands in premiums for health insurance go to pay the hospital bills of a very few.

    It would be cheaper by far if we made Medicare Part A the payor of last resort for the uninsured.

    The uninsured could pay an extra payroll tax of about 3%, and Americans a whole would pay less than one half of one percent in additional payroll taxes.

    Why so cheap? because less than 4% of young people ever see a hospital, maybe a little higher if you include childbirth.

    Adding onto Medicare Part A would be far cheaper than Obamacare, and require no new bureaucracy.