Ten Obamacare Predictions for 2014
It’s not going to be a good year for the law.

HHS Secretary Kathleen Sebelius


7. Tens of millions will see employer plans canceled: The next wave of lost coverage will be among those receiving health insurance through small businesses. Most do not self-insure (the way big companies do), and the health-insurance policies that businesses renewed in 2013 under the old rules will expire in waves throughout 2014 because they don’t meet the law’s new mandates. Expect to see many more news articles reporting on the next cascade of lost policies.

8. Most of the newly insured will be on Medicaid: The more heavily subsidized insurance is, the more likely people are to enroll. Medicaid is free to patients, or nearly so, so it’s likely to see the greatest enrollment. In Kentucky, for example, 85 percent of those enrolling so far are on Medicaid or the Children’s Health Insurance Program.

9. Fewer insurance companies will participate in 2015: Many insurance companies took a “watch and wait” attitude to participating in the Obamacare exchanges in the first year. Those that did participate have invested hundreds of millions of dollars to structure plans that comply with the law. But as the rules change, sometimes daily, these companies have been sent into a frenzy to comply with the new directives. Those who bought in and those who didn’t will look carefully at whether or not they will participate in 2015. If they don’t, people will have even fewer choices of plans, and premiums will be even higher next year.

10. Court cases will continue: Legal challenges will continue to march through the courts, and at least some are likely to succeed. Private companies and religiously affiliated charities face ruinous fines if they fail to comply with the mandate that they provide free coverage for their employees for contraceptives, sterilization, and abortifacient drugs, despite their strong religious objections. Lower courts have granted preliminary injunctions in 18 of the 20 cases they’ve heard so far.

A number of other suits are challenging the IRS rule that authorizes subsidies for health insurance in the federal exchanges — which the law clearly doesn’t provide for – and decisions are expected early this year on that matter in federal district courts. And eleven state attorneys general are challenging the Obama administration’s decision to simply stop enforcing the Affordable Care Act’s mandates, including the latest directive to allow insurance companies to keep offering health plans that had been canceled.  While the attorneys general support continued coverage, the way the president did it is “flatly illegal under federal constitutional and statutory law,” they claim; lawsuits are likely.

All of these predictions should make another fair bet: Before the 2014 elections, Congress will send legislation to the president to soften the blow of Obamacare, most likely delaying the individual mandate by at least a year. If that happens, the center pole in the Obamacare tent comes down, and the door will open wide for major, structural changes to the law in 2015.

— Grace Marie Turner is the president of the Galen Institute.