The Squeaky-Wheel Problem in Obamacare Coverage

The upper-middle-class self-employed people in the individual market can stir up a lot of dust, even if they represent a tiny fraction of the population.
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Kai Pfaffenbach/Reuters

Conservative writer David Frum points to something in a column today that I think explains a lot of the somewhat-overwrought coverage of the individual insurance market:

Talking Points Memo today offers a chart suggesting that the losers under Obamacare will number about 3 percent of the population. Why, that’s only … 9 million people. Nine million of the best educated, most affluent, and most vocal people in the country. How much trouble can they make? So really—it’s no story. 

It's all well and good to argue that only a small fraction of Americans will see premium increases in the individual market, but most of those who are seeing them—and who also are subsidy-ineligible under Obamacare—are from the middle to upper-income part of the middle class. More than 40 percent of people in the individual market are there because they are self-employed or running a small business. They're entrepreneurial and independent-spirited by nature, and when they squeak, they make a lot of noise.

By contrast, I'll be shocked if we see nearly as much attention devoted to the personal stories of the tens of thousands of low-income people now getting insurance through Obamacare's Medicaid expansion. Instead, we get experts tut-tutting over whether the planned expansion that's intended to cover an additional 9 million near-poor people over the next year is going to be a burden on the states.

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Garance Franke-Ruta is a former senior editor covering national politics at The Atlantic.

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