A correction in NYT ACA coverage

The New York Times has an excellent front-page story by Abby Goodnough today detailing the "blessings and hurdles" that various people seeking health insurance in Kentucky have encountered under the Affordable Care Act. A key point in one of the marquee narratives did not compute, however.

A certain David Elson, 60, was reported in today's print editions to earn $22k and be eligible for cost-sharing subsidies that would lower his deductible -- but also unable to pay his first monthly premium, reduced via a monthly subsidy of $250 to $350.  In fact, a 60 year-old nonsmoker anywhere in the country earning $22k should be able to access a silver plan for around $100 per month, with Cost Sharing Reduction (CSR) reducing the deductible to under $1000 per month.

"What if Obamacare works?" -- What Ross Douthat leaves out

Ross Douthat "fairly fairly" describes the differences between the cheapest health insurance plans available on the ACA exchanges and the cheapest plans currently available on the individual market, most of which will be phased out because they don't comply with ACA minimum coverage requirements.  But he leaves some important facts out.

Douthat acknowledges that the ACA's premium subsidies will offset the price increase for many who buy on the exchanges, and he fairly if too briefly presents the limitations of a cheap plan currently available on the individual market ("a $5,000 deductible, an annual out-of-pocket limit of $12,500, and all kinds of copays and coverage restrictions"). He then frames the ACA's political prospects like this:

With some grandfathered exceptions, Obamacare makes those kinds of plans illegal. The out-of-pocket limit for individuals is capped at $6,500 a year, preventive services are fully covered, and various “essential benefits” as well. 

If we ever get beyond the follies of HealthCare.gov, the politics of the rollout will probably be defined by how (and how vocally) middle-class Americans just above the subsidy threshold react to this “pay more, get more, subsidize other people” deal.

True, perhaps -- though the politics will also be defined by the reactions of those eligible for the subsidies, and those shut out of the current market by preexisting conditions or age (the ACA limits age-related price differentials to 3-to-1; currently they're as high as 6-to-1), or, to a lesser extent, by those newly eligible for Medicaid (who are less likely to be politically vocal and perhaps less likely to recognize that their new benefits are a product of the ACA).

It's Douthat's presentation of the likely long-term consequences of a successful ACA rollout that tilts our view of past and future playing fields: