“A Million Here, A Million There”: Millions Of People Have Health Insurance Thanks To Obamacare
The big number in the news this week was 1.1 million – the number of people who signed up for health insurance through Obamacare’s federal insurance marketplace this year. This is an important figure, especially given the fact that it stood at little more than 100,000 at the end of November.
Nevertheless, that 1.1 million figure dramatically understates what the Affordable Care Act has already accomplished. The number we should be talking about is at least 9 million and could be 14 million people who are currently getting coverage under the law.
How many people are currently covered through the law? Start with the 1.1 million who have gotten care through the federal website. If you layer on the number of enrollees who have gotten coverage through state-run exchanges that number tops 2.1 million, Secretary of Health and Human Services Kathleen Sebelius announced Tuesday. Then throw in the 3.9 million people who have gotten health coverage under Obamacare’s Medicaid expansion. Oh and don’t forget about the young adults under 26 who are still covered by their parents’ health insurance plans thanks to the Affordable Care Act. A year-and-a-half ago, the Department of Health and Human Services put the number at 3.1 million but an August study by the Commonwealth Fund, a private foundation that focuses on health policy research, estimated that the figure had reached 7.8 million. Total those numbers and you get a minimum of 9 million Americans covered through Obamacare and a maximum of nearly 14 million.
To borrow Everett Dirksen’s old adage: A million here, a million there, and pretty soon you’re talking about real coverage. This is why Wisconsin Sen. Ron Johnson told the New York Times last week that the Affordable Care Act is “no longer just a piece of paper that you can repeal and it goes away. … We have to deal with the people that are currently covered under Obamacare.”
To be sure there are provisos and qualifications. Obamacare critics will point out that some number of those insured are only replacing coverage they lost thanks to the law disqualifying their plans (of course that will require those same critics to acknowledge that very few of the people losing their health coverage are now bereft); and in the context of 50 million uninsured it’s only a start – but it is a start. And while I’m writing this in the waning hours of 2013, it doesn’t take a great feat of prognostication to know that the first days of 2014 may well bring another round of Obamacare horror stories as people find out that they don’t have coverage they thought they signed up for. The October website disaster’s effects are still being felt – the administration had been aiming for 3.3 million signups by now, for example, so the 2 million figure is well short.
The law’s well-publicized stumbles have certainly taken their toll in polls. Finally clear of its shutdown self-immolation, the GOP seems to be building its 2014 strategy around Obamacare’s flaws. “Ideally, we’d freeze things the way they are in amber until November,” a senior House Republican aide told Time’s Jay Newton-Small last month.
But putting aside for a moment the fact that 11 months is an age and a day in politics, there’s a fundamental flaw in this GOP calculus: Obamacare’s not the cutting issue they seem to think it is. Democratic pollsters Stan Greenberg, James Carville and Erica Seifert surveyed the 86 most competitive House districts and found that the country remains deeply divided on the Affordable Care Act. “Health care is not a wedge issue,” they concluded.
The right’s problem is that it fixates on approval-disapproval numbers without digging into them. So while a CNN/ORC poll conducted in mid-December found that 35 percent favor the law and 62 percent oppose it, only 43 percent oppose the law because it’s too liberal; if you add the 35 percent who favor the law to the 15 percent who dislike it because they wish it did more, the GOP 2014 game plan becomes more puzzling. An early December New York Times/CBS News poll tells the same story: 50 percent oppose the law while only 39 percent approve. But only 42 percent think the law goes too far while a total of 50 percent think it either doesn’t go far enough or is just right.
Those are the figures right now. But in February of last year, the Congressional Budget Office estimated that 7 million people would be covered this year through the exchanges. Is that figure realistic? The Washington Post’s Obamacare guru, Sarah Kliff, reported this week that the health research firm Avalere Health estimated what the pace of enrollments should look like, modeling it off of the 2006 Medicare drug program rollout. Their guess for Obamacare was 2.4 million people by the end of 2013, making the 7 million target plausible.
One factor which will help? The health insurance industry is going all-in on the law. As the Wall Street Journal reported last month, health insurers are fighting for these millions of new customers. The Journal suggested that insurers will spend $500 million on local TV ads in 2014. Here’s my favorite part of the article: “The ad campaigns are a major shift in strategy for health insurers, most of whom have never really had to market directly to consumers aggressively until now.” It’s the free-market flipside of Obama’s infamous promise: If you don’t like your insurer, you don’t have to keep it. A full fight for customers could help the law reach the 7 million mark – bringing the total number of people insured under it to nearly 20 million.
Is the GOP really going to spend the fall campaigning to take health care away from nearly 20 million people?
By: Robert Schlesinger, U. S. News and World Report, January 3, 2014
“Stunning New Report Undermines Central GOP Obamacare Claim”: The Arguments Made By Republicans Simply Lack A Firm Factual Basis
A crucial GOP line of attack against the Affordable Care Act (ACA) is that millions of people will supposedly lose coverage thanks to shifting requirements on the health insurance exchanges — a flagrant violation of President Obama’s infamous “if you like your plan, you can keep it” proclamation. The truth has always been more complicated, of course. Republicans are constantly blurring the line between people who lose a plan and people who lose coverage. That is, many people might lose a particular insurance plan but immediately be presented with other options.
Now, a new report from the minority staff of the House Committee on Energy and Commerce has destroyed the foundation of that particular GOP claim. It projects that only 10,000 people will lose coverage because of the ACA and be unable to regain it — or in other words, 0.2 percent of the oft-cited 5 million cancellations statistic.
The report starts with an assumption that 4.7 million will receive cancellation notices about their 2013 plan. (Notably it doesn’t endorse that figure, just takes it on for the sake of argument.) But of those, who will get a new plan?
- According to the report, half of the 4.7 million will have the option to renew their 2013 plans, thanks to an administrative fix this year.
- Of the remaining 2.35 million individuals, 1.4 million should be eligible for tax credits through the marketplaces or Medicaid, according to the report.
- Of the remaining 950,000 individuals, fewer than 10,000 people in 18 counties will lack access to an affordable catastrophic plan.
“This new report shows that people will get the health insurance coverage they need, contrary to the dire predictions of Republicans,” said Rep. Henry Waxman (D-Calif.), the ranking committee member. “Millions of American families are already benefiting from the law.”
The report is somewhat speculative, of course, since there is no central repository of data on the individual health insurance market. But the methods are clear, and the onus is now on Republicans to explain why it isn’t true.
As we’ve noted, Republicans have had an awful hard time finding people who completely lost coverage because of the ACA. (Think of the man who starred in Americans for Prosperity ads last week and whose story still hasn’t been fully explained.) Perhaps it’s because there just aren’t that many of them.
Of course, there’s no doubt that for those 10,000 people, the health-care law left them worse off than before. And by no means is the rocky political ride over for Democrats — back-end problems still present a serious threat to implementation. But as is sadly too often the case, the arguments made by Republicans simply lack a firm factual basis — and deserve much more scrutiny that they’ve received in many sectors of the mainstream press.
By: George Zornick, The Plum Line, The Washington Post, December 31, 2013
“Call It A Comeback”: More Than 9 Million Americans Have Health Insurance Through Obamacare
You don’t get much credit for fixing something that should have worked in the first place, but the Obama administration has avoided a major catastrophe by delivering on its promise to fix HealthCare.gov for most Americans.
After two months of barely functioning, the federal online health care exchanges delivered, racking up 975,000 enrollments in the month of December. That brings the total number of people who have picked a plan through an exchange since October 1 to about two million. The administration reached about two-thirds of its goal of enrolling 3.3 million by the end of 2013 after being fully operational one-third of the time. And it turns out most of the enrollments came during the one-week extension the White House gave itself after the initial problems with the site became apparent.
Four million people have qualified for Medicaid, according to ACASignups.net. Another 3.1 million young adults are covered by their parents’ health insurance, thanks to a provision in the Affordable Care Act (ACA).
This means over nine million people have gained coverage through the ACA since it first became law.
That number could easily shrink or grow as insurers report on how many people purchased ACA-compliant policies directly through them. It’s also unclear how many canceled policies were replaced by plans purchased through the exchanges.
Looking at the rate of enrollments for Medicare Part D, president of health research firm Avalere Health Dan Mendelson believes that the administration can hit its goal of seven million enrollments by the close of open enrollment on March 31.
“Where they are, with about two million enrolled, if they continue to enroll at the present rate, and there’s a little acceleration at the end, they could get to seven million,” Mendelson told the Washington Post‘s Sarah Kliff.
However, Republicans are still predicting doom for the president’s signature legislative accomplishment, suggesting that the disastrous rollout of the exchanges is just the beginning of the problems.
“Just about everyone on the right is still living in October, the annus horribilis of Obamacare (yes, I know it was just a month, and I don’t care), and is waiting to move in for the kill after the whole thing collapses,” The New York Times‘ Paul Krugman wrote.
Republicans are assuming that the estimated 3 percent of Americans who will be paying more under the law along with disruptions of relationships with doctors will overwhelm both the news of millions gaining coverage and Republican states denying Medicaid expansion to five million working people.
Predictions of Obamacare’s death made sense when it seemed a very real possibility that HealthCare.gov could not be fixed.
Now that those predictions have been proven wrong, the law will have a chance to be judged on its merits.
By: Jason Satler, The National Memo, December 30, 2013
“Things Are Looking A Lot Better”: We Don’t Know If Obamacare Is Working Well, But We Know It’s Working
Obamacare got off to a lousy start. But things are looking a lot better now.
Nearly a million people signed up for private health plans via healthcare.gov in December, according to statistics the Obama Administration released on Sunday morning. That pushed the total number of sign-ups for the year to 1.1 million. Combined with the totals that states are likely to report by year’s end, it probably means more than 2 million people have signed up for private health insurance though the Affordable Care Act’s marketplaces. That doesn’t count several million who enrolled in Medicaid, the newly expanded federal-state program that provides insurance to low-income people.
The official enrollment number doesn’t tell us many things. It doesn’t tell us whether these people getting private (or public) coverage had insurance previously—or, if they had insurance, how much they were paying for it. It doesn’t tell us how many of these people have actually paid premiums, which is essential for coverage to take effect. It doesn’t tell us whether insurers have proper data on these people or what kind of access and protection the new coverage will give. It doesn’t tell us how many of the enrollees are in relatively good health or how many are in relatively poor health—or how that mix will affect insurance prices going forward.
In addition, the numbers do not appear to match the Administration’s own targets. According to internal projections, later reported by the Associated Press, officials expected more than 3.3 million enrollments by year’s end, with about 1.8 million of those coming through the federal website.
For all of those reasons, and a few others, it’s premature to say Obamacare is meeting expectations.
But those internal enrollment targets don’t include people who signed up for coverage directly through insurers. And while lower-than-predicted enrollment could be a sign consumers don’t like the new policies, they could also represent the lingering effects of the site’s technical problems. The internal projections were never particularly scientific: Administration officials extrapolated them from the Congressional Budget Office’s projection of overall private plan enrollment in 2014 (about 7 million) and with necessarily imperfect data from prior programs. “What’s important now is that the systems are mostly functioning so that anyone who wants to get coverage can,” says Larry Levitt, senior vice president at the Kaiser Family Foundation. “The outreach campaigns and advertising by insurers likely haven’t peaked yet, so I wouldn’t be at all surprised if enrollment in March is even bigger than December.”
MIT economist Jonathan Gruber, an architect of reforms, has a similarly nuanced take. “Given the technical problems at the start, and given that the important deadline is March 31, what matters right now is the trend in enrollment. In terms of overall enrollment, the trend looks quite good,” Gruber says. “What matters more is the mix in terms of the health of those enrolling, and we won’t have a clear answer on that until we see 2015 rates from insurers.”
While we wait to see more numbers—and parse the meaning of the numbers we have—we do know a few things for sure.
We know, first and foremost, that healthcare.gov is a (mostly) functioning website. This was no sure thing even a few weeks ago. At the end of November, when officials announced that they had met their goal of constructing a website that worked well for most customers, they were cautious to warn about future problems. Partly that was because their previous predictions of success proved so unbelievably wrong. And partly that was because they feared a late surge of customers would overwhelm the site’s capacity, threatening a whole new period of chaos. But the system held up just fine, as the high enrollment numbers indicate.
More important, we know that many of the people getting insurance are very, very happy to have it. In the fall, when insurers began sending notices of rate increases and plan cancellations, all we heard about was people unhappy with—and in many cases angry about—their new options. Now, however, we are increasingly hearing stories about people who are saving money and, in some cases, getting access to health care they’ve desperately needed for a long time.
Here two examples, culled from a new story by Lena Sun and Amy Goldstein in the Washington Post:
Adam Peterson’s life is about to change. For the first time in years, he is planning to do things he could not have imagined. He intends to have surgery to remove his gallbladder, an operation he needs to avoid another trip to the emergency room. And he’s looking forward to running a marathon in mid-January along the California coast without constant anxiety about what might happen if he gets injured.
These plans are possible, says Peterson, who turned 50 this year and co-manages a financial services firm in Champaign, Ill., because of a piece of plastic the size of a credit card that arrived in the mail the other day: a health insurance card. …
Dan Munstock knows this. A 62-year-old retiree in Greenville, Tenn., he hasn’t had insurance since he left his job as a crisis counselor in Miami six years ago. He lives on Social Security income of less than $15,000 a year. Although he does not know of any major ailments, he would like a checkup because, he said, “you can seem fine until the day you drop over with something.”
Like thousands of other Americans, Munstock ran into technical problems with the federal Web site before managing to pick a health plan Dec. 1. He qualified for a federal subsidy to help him afford the insurance, so he has to pay just $87.57 a month toward his premium. After his welcome packet from Blue Cross Blue Shield of Tennessee arrived in the mail, Munstock was so eager to finish the process of enrolling and getting an insurance card that he picked up the phone to pay the first premium instead of using the mail.
“It felt really good,” he said. Paying toward his own insurance, he said, gives him “a certain dignity,” a feeling that he is not “one of the takers.” The next day, he called the doctor’s office. His appointment for a physical is Jan. 2. …
Like the stories of rate hikes and plan cancellations, anecdotes of people gaining insurance or saving money will frequently prove more complicated than they seem at first blush. Some people will discover they owe more out-of-pocket costs than they imagined, because of high deductibles and co-payments. Some won’t be able to see the doctors they want, because plans have limited networks of providers. Some will haggle with insurers over particular bills or services. And that’s not to mention the many other trade-offs in the law—like higher taxes on the wealthy, cuts to various industry groups, higher premiums for some people buying their own coverage, and other steps that made possible the law’s expansion of health insurance.
But nobody ever promised that Obamacare would solve all of the health care system’s ills—or that it would come without costs of its own. The goal has always been to make insurance more widely available, so that more people had access to care and protection from crippling medical bills, while beginning the difficult work of reengineering medical care to make it more efficient. The new enrollment numbers should give us new reason to think it will.
By: Jonathan Cohn, The New Republic, December 29, 2013
“More Bark Than Bite”: Tomorrow’s Obamacare Controversy, Today
If past is precedent, Republicans on the House Oversight Committee will soon release a draft memo they requested and received from the Health and Human Services Department just before most Washingtonians decamped for the Christmas holiday.
At first glance, the memo, obtained by National Journal, looks very bad for the Obama administration. In the Sept. 24 document, a top information security officer for the agency overseeing the Obamacare insurance exchanges warns that the marketplace “does not reasonably meet … security requirements” and that “there is also no confidence that Personal Identifiable Information (PII) will be protected.” Teresa Fryer, the chief information security officer at the Centers for Medicare and Medicaid Service, continues: The federal marketplace will likely “not be ready to securely support the Affordable Care Act … by October 1, 2013.”
It plays right into the Republican narrative about HealthCare.gov: The administration knew the website would not be ready by the launch date but went ahead with it anyway. And the site may still not be adequately protecting consumers’ information.
But, in context, the draft memo becomes much less exciting.
On the Friday before Christmas, Rep. Darrell Issa, the chairman of the House Oversight Committee, released a partial transcript from an interview conducted by the panel’s staff with Fryer. That partial transcript, shared with ABC and CBS, suggested that Fryer warned the administration that there were two findings of serious vulnerabilities in the system.
However, when Democrats on the Oversight Committee released parts of the transcript omitted from Issa’s version, Fryer’s comments looked far less explosive, and ABC updated its story to reflect the change. It turns out that by Sept. 27, a few days after Fryer raised her concerns about the security at launch, extensive new security measures were added.
As she told the committee’s investigators, “The added protections that we have put into place in accordance with the risk decision memo … are best practices above and beyond what is usually recommended.” She went on to describe her confidence in the three-level security system and to note that there have been “no successful breaches [or] security incidents.”
Which brings us back to the draft memo we obtained. We should note that it was just a draft, and was never sent or reviewed by more senior officers in the chain of command, and was written three days before the mitigation strategies went into effect. She later told Oversight Committee investigators that her earlier recommendation against giving the go-ahead to launch the site—the “authority to operate,” as it’s called—did not take into account the mitigation strategies laid out in the Sept. 27 Authority to Operate memo.
The investigators asked Tony Trenkle, then-CMS’ top information executive, this: “So as long as the mitigation strategy described in the [ATO] memo was carried out, you considered that it was, it would be sufficient to mitigate the risks described in the memo?” He responded, “Yes.”
She added that she was “satisfied” with the current security testing, and that she did not object when another CMS information security officer decided to move ahead with the launch. Again, she stated: “All systems are susceptible to attacks. There have been no successful attempts.”
As the Los Angeles Times‘ Pulitzer Prize-winning business columnist Michael Hiltzik noted, “Issa has absolutely no evidence” to support his broader claims that the system’s deep vulnerabilities put all kinds of consumers’ government data at risk, and that CMS moved ahead anyway to avoid embarrassing the White House.
Of course, sleight of hand with opaque bureaucratic documents is nothing new for Issa, but the potential to dissuade Americans from obtaining health insurance through the federal exchanges because of trumped up security fears has pushed relations between the committee chair and the administration to a new low. It’s one thing to say without evidence that the administration is corrupt, but it’s another to tell Americans that their Social Security number is at risk when there’s nothing to suggest that’s true.
But perhaps we can head off another round of this farce by putting out Fryer’s memo before Issa does—in its full context.
By: Alex Seitz-Wald, The National Journal, December 24, 2013
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