A recent analysis by Lawrence Wilson in The Epoch Times argues that the Affordable Care Act's fundamental design flaws made dramatic premium increases inevitable from the outset. The article presents evidence suggesting that despite promises to "bend the cost curve," Obamacare's structural elements guaranteed significant cost escalations for consumers.
During the implementation phase, multiple experts warned about potential cost consequences. The Board of Health Care Services at the National Academies cautioned in 2012 that requiring coverage for extensive "essential health benefits" could make insurance prohibitively expensive, potentially undermining the ACA's core purpose of expanding coverage.
The warnings proved prescient. According to data cited, between 2010 and 2022, medical costs increased approximately 16%, while ACA marketplace premiums surged by 73% - more than four times the underlying medical cost inflation. Insurance industry groups had anticipated these issues, with America's Health Insurance Plans warning regulators that essential health benefits requirements would have "far-reaching implications" on affordability.
The article identifies several structural problems:
1. **Adverse Selection**: The ACA created incentives for healthier individuals to avoid purchasing insurance until needed, while guaranteed issue meant sicker individuals could purchase coverage at any time, creating a risk pool skewed toward higher medical costs.
2. **Mandatory Benefit Requirements**: By requiring coverage for numerous services regardless of individual needs, the Act pushed up baseline costs for all recipients.
3. **Community Rating Restrictions**: Limiting price variations based on health status forced insurers to price policies based on average utilization costs rather than individual risk factors.
The COVID-19 pandemic further exacerbated these issues, prompting Congress to implement enhanced premium subsidies in 2021 that temporarily masked premium increases. These subsidies, which expired in 2025, had driven enrollment to an all-time high of 24.3 million. Without them, the article suggests consumers will face the full impact of rapidly rising premiums.
According to Wilson, the ACA's design created what economists call a "death spiral" - premiums must rise to compensate for a risk pool containing a higher proportion of expensive medical cases, which in turn drives healthier individuals out of the market, further worsening the risk pool composition.
The article concludes that until these structural issues are addressed, American consumers will continue experiencing unsustainable premium increases that far outpace medical cost inflation, undermining the ACA's original objectives of affordable, accessible healthcare coverage.
Editorial comments expressed in this column are the sole opinion of the writer
