1. The ACA as enacted (including the individual mandate). Compared with the era before healthcare reform, the number of people with private coverage increases by 7.4 million because the ACA significantly increases the demand for private insurance. Medicaid gains 16.4 million members. The number of uninsured is cut almost in half to 26.4 million and the cost of uncompensated care drops by 50% to $39 billion. As enrollment increases, spending is up across the board. Government spending increases by $87 billion to $340 billion. Employers and individuals each spend $11 billion more or $540 billion and $371 billion, respectively.
2. High interest in HIX and enrollment is strong. State-base health insurance exchanges, (HIX) where individuals and small businesses can purchase insurance coverage, are supposed to be up and running by 2014. Private coverage loses 3.6 million members as many shift to HIX; Medicaid posts smaller enrollment gains than with the individual mandate adding about 13.9 million members. Nearly 40 million remain uninsured; the cost of uncompensated care is $59 billion. Without the mandate and with lower enrollment, healthcare spending is down across the board. Government spending decreases by $10 billion. Employers slash spending by $34 billion, and individuals spend $29 billion less.
3. Low interest in HIX and low enrollment. This scenario looks at how a lack of publicity and low carrier participation could affect enrollment and spending. Without the individual mandate, private coverage loses an estimated 10.7 million enrollees; Medicaid loses 2.9 million members. The number of uninsured is 40 million and the cost of uncompensated care remains at $59 billion. The government spends $14 billion less on healthcare. Employers and individuals see their spending drop by $30 billion and $25 billion, respectively.