Is the ACA reducing underinsurance?

About 16 percent of the U.S. population has no health insurance. Reducing that percentage by more than half is a primary purpose of the Affordable Care Act. As subsidized coverage in a reformed individual market has become available for the first time in 2014, news coverage has understandably focused mainly on how many previously uninsured people are gaining coverage.

But the ACA also rewrote the rules governing what kinds of coverage health insurance policies had to offer. The revamp was designed to address a problem nearly as pressing as reducing the ranks of the uninsured: tens of millions of Americans were also underinsured, or unreliably insured.  Coverage was subject to annual or lifetime caps and to arbitrary rescission.  Essential benefits such as hospitalization, mental healthcare, rehabilitative care and childbirth were excluded from many policies.

Many ACA provisions designed to end underinsurance have been in effect for some time  -- the ban on lifetime coverage limits has been in place since September 23, 2010, as has mandatory free coverage for a long list of preventive services, including birth control  I would like to examine the extent to which serious uninderinsurance has already been reduced.  What follows is a kind of scope-of-question outline -- a few questions, a few premises, a few observations.

The ACA's pre-existing condition

Ezra Klein is that rare interviewer whose questions are determined almost as much by what his interlocutor just said as by what he's got planned.  That often includes teasing out real or apparent contradictions between two statements in the interview. So it was in this exchange between Klein and healthcare consultant/ACA critic Robert Laszewski:

K: That brings up two issues. The first is the individual mandate, which begins this year but is a much bigger penalty in year two, and then even bigger in year three. So one question here is how well that works.

RL: I have an interesting answer for that. I think the mandate is almost worthless because the word is getting around that they can’t really collect it. And by year three, it’s really a lot of money. I think there’ll be real pressure to just get rid of it. I don’t think you can force people to buy this insurance. If they don’t want it there’ll be a political groundswell to get rid of it. So in my mind the individual mandate is kind of irrelevant to this.

WSJ leans into the "rate shock" narrative for Obamacare

[Updated 7/13, per "Blows to Obama's Health-Care Law Pile Up"...]

The WSJ's Louise Radnofsky is an experienced healthcare reporter, and her front-page story today about pending "rate shock" for healthy singles when the ACA takes effect is factually accurate. Since the focus is on the risk that the healthy uninsured will stay out of the ACA's healthcare exchanges, it's arguably fair to focus on the subset -- a minority of those who don't get insurance from an employer or the government -- whose premiums may go up. But nonetheless I find the emphasis and framing misleading in some particulars (e.g., the online home page teaser, "Insurance Rates Could Soar Under New Law"). .

The lede goes for maximum shock effect, setting reader perceptions before multiple caveats qualify the picture: