With immigration, the Trump wall and the Hillary pathway dominating the pre-Labor Day electioneering, whatever happened to the Affordable Care Act?

As a debating point, I mean.

News stories have been appearing for months now. Insurers like Aetna say they’re losing money on Affordable Care Act health insurance exchanges. So they’re pulling out of that end of the market. Too few healthy people are enrolling, spoiling the assumptions underpinning the law. Many people would rather pay the fine, er, tax, rather than buy a plan that might cost ten times as much.

Years after passage and enactment, the ACA is still a prism refracting people’s fundamental view of what government should or should not do. Some look at it and see rising prices, lack of competition, and yet another expensive subsidy program. Others see millions more people with insurance than before, under a program that just needs time to stabilize. Some insurers, they point out, are expanding their ACA offerings.

Whether you support it fully or think it should be pulled out by the roots, ACA is not jelling as its backers envisioned. At least not yet. The Health and Human Services Department has built a gigantic apparatus around it, as have those states with their own insurance exchanges. The IRS has the non-trivial job of enforcing the enrollment mandate.

So far, the election has consisted mainly of candidates and their camps calling one another names. But given that ACA is not yet successful, and given how bitter the debates were leading up to its passage, I’m thinking it will reemerge as a debating point for both sides, and a renewed policy argument after the election.

For instance:

If the penalties, er, taxes on the uninsured too low to motivate them (or coerce them, depending on your point of view) to buy insurance, should the answer be to raise the tax or get rid of it altogether?

If some ACA districts end up with one or zero insurers on their exchanges, do you compel the biggies to offer plans or have the government move in with a plan of its own, sort of like Medicare with a premium?

If prices on the exchanges are too high, do you regulate them or add to the subsidies?

If insurers’ profits are a linchpin in the ACA, is anyone looking at their overhead costs?

The questions go on and on. At the heart of every answer is a political view. A philosophy.

Insurance and health care itself aren’t getting less expensive. That will keep questions about ACA’s future in play. Single payer, tinker with existing plan, or back to open-market competition. It’s going to move one way or the other.

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