“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
“Republicans Could Care Less”: Millions More Denied Coverage By GOP Refusal To Expand Medicaid Than Obamacare Cancelations
For weeks as HealthCare.gov foundered, Republicans focused on President Barack Obama’s claim that “if you like your plan, you can keep it,” which was dubbed PolitiFact‘s Lie of the Year. Republicans purposely neglected to differentiate between the number of Americans whose plans were being canceled and those whose entire coverage was lost.
Now it turns out that the millions of notices that were sent out will result in just thousands of Americans losing access to affordable insurance.
A new report, however, from the minority staff of the House Committee on Energy and Commerce shows that only 0.2 percent of the approximately five million cancelations – the number often referenced by the Republican Party – will lose coverage because of Obamacare, and be unable to regain it.
In other words, only 10,000 people will lose complete coverage.
The report assumes that 4.7 million people will receive cancelation letters about their current plans. It then finds that half of that number will have the option to renew their 2013 plans, due to an administrative fix to the health law. Of the remaining 2.35 million Americans, 1.4 million would be eligible for tax credits through the ACA exchanges or Medicaid coverage, and out of the 950,000 individuals left, according to the report, “fewer than 10,000” people would lack access to an “affordable catastrophic plan.”
As the Washington Post notes, “there’s no doubt that for those 10,000 people, the health care law left them worse off than before.” Still, that number is significantly less than the amount of people who did not have access to any coverage prior to Obamacare.
“This new report shows that people will get the health insurance coverage they need, contrary to the dire predictions of Republicans,” says Democratic representative Henry Waxman (CA). “Millions of American families are already benefitting from the law.”
Ironically, as Republicans fret over the approximate 10,000 people who will lose coverage in 2014, they are to blame for the nearly five million Americans who will not have any health insurance this year because of the GOP’s refusal to expand Medicaid in various states across the country.
Though the Affordable Care Act provides complete funding through 2016 for Medicaid expansion in all states – and 90 percent funding in the following years – 25 Republican-controlled states have still refused to expand the program that offers coverage to the poor.
As a result, approximately 4.8 million people will find themselves inside the so-called “coverage gap,” which one report suggests could cost 27,000 Americans their lives in 2014.
By: Elissa Gomez, The National Memo, January 1, 2014
“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
“Millions And Millions”: How Many People Has Obamacare Helped?
As the deadline to sign up for an insurance policy that takes effect in 2014 passes on December 23, the next crucial step in the debate about the future of the Affordable Care Act begins.
On January 1, Republicans will make the case that because of the estimated five million cancelation notices that went out last year, more people are uninsured under the president’s signature legislative accomplishment than newly insured.
The White House is preparing to rebut that argument aggressively. Last week, an administration official asserted that only about 10 percent of those who received those notices had not found a replacement plan, as most were offered another option by their current insurer. The remaining 500,000 or so have been offered a special exemption from the individual mandate.
But it will be almost impossible to know right away if the number of net insured went up in January, The Washington Post‘s Sarah Kliff explained on Friday.
“It’s the exact opposite of weather forecasting,” Stan Dorn, a senior expert at the Urban Institute, told Kliff. “There, you can be pretty confident of what will happen tomorrow but no idea about the future. Here it’s the reverse: Over time there will be significant gains, but that will take years, not months.”
All we have now is estimates, as some states are reporting signups and some are announcing actual enrollment numbers. As of Friday, 3.3 million people had signed up for insurance through the Affordable Care Act, with at least 970,000 of them having enrolled in private insurance plans, according to ACAsignups.net.
But these numbers don’t tell the whole story, Campaign for America’s Future’s Dave Johnson points out:
—71 million Americans on private insurance have gained coverage for at least one free preventive health care service such as a mammogram, birth control, or an immunization in 2011 and 2012. In the first 11 months of 2013 alone, an additional 25 million people with traditional Medicare have received at least one preventive service at no out-of-pocket cost.
—Up to 129 million Americans with pre-existing conditions—including up to 17 million children —will no longer have to worry about being denied health coverage or charged higher premiums because of their health status.
—Approximately 60 million Americans have gained expanded mental health and substance use disorder benefits and/or federal parity protections.
—41 million uninsured Americans will have new health insurance options through Medicaid or private health plans in the Marketplace. Nearly 6 in 10 of these individuals could pay less than $100 per month for coverage.
—Consumers have saved $5 billion over the past two years due to a new requirement that insurance companies have to spend at least 80 percent of premium dollars on care for patients (at least 85 percent for large group insurers). If they don’t, they must send consumers a rebate. In 2013, 8.5 million enrollees will receive rebates averaging $100 per family.
—Insurance companies must submit premium increases of 10 percent or more for review by experts. In 2012, 6.8 million Americans saved an estimated $1.2 billion on health insurance premiums after their insurers cut back on planned increases as a result of this process.
—Since the health care law was enacted, more than 7 million seniors and people with disabilities have saved an average of $1,200 per person on prescription drugs as the health care law closes Medicare’s “donut hole.”
—Over three million young adults have gained health insurance because they can now stay on their parents’ health plans until age 26.
—Individuals no longer have to worry about having their health benefits cut off after they reach a lifetime limit on benefits. Starting in January, 105 million Americans will no longer have to worry about annual limits, either.
—Using funds available through the Affordable Care Act, health centers are expanding access to care by building new sites and renovating existing sites. Health centers served approximately 21 million patients in 2012.
The millions and millions of people who’ve been helped by the law won’t be counted as the press tries to game out if Obamacare will reach the seven million private insurance signups the Congressional Budget Office predicted for its first year. But they’re definitely out there, and they’d be among the millions who would be affected if the GOP is ever successful in repealing the law.
By: Jason Sattler, The National Memo, December 22, 2013
“What Obamacare Death Spiral?”: So Sorry Republicans, The Rumors Have Been Greatly Exaggerated
Supporters of the Affordable Care Act have been terrified for months now that a combination of a botched online enrollment system, terrible press, and Republican sabotage could send the individual market part of the new system into the much-discussed “death spiral” where a disproportionately large population of older and sicker enrollees would produce very high premiums, which would in turn repel younger and healthier eligibles even more, creating a self-perpetuating disaster.
At Wonkblog today Sarah Kliff reports some research from the Kaiser Family Foundation indicating that fears of a “death spiral” are significantly overblown:
The rumors of an Obamacare death spiral have been greatly exaggerated. So say Larry Levitt, Gary Claxton and Anthony Damico, experts at the Kaiser Family Foundation who have put together a new brief analyzing what would happen if young adults snubbed the Affordable Care Act. Even if young people sign up at half the rate the administration hopes for, it would nudge premiums up only by a few percentage points, their report says.
“When you do the math, it matters, but not nearly as much as the conventional wisdom suggests,” Levitt says….
If young adults (those under 35) were 25 percent less likely than the rest of the population to sign up for Obamacare, they would represent 33 percent of exchange enrollees — rather than 40 percent. This means there would be fewer young people to subsidize older insurance subscribers. To make up that difference, the experts estimated, insurers would need to increase premiums by a terrifying … 1 percent. Yes, exactly 1 percent.
Levitt, Claxton and Damico also tested a scenario where young adults are half as likely as older shoppers to enroll. In that case, the younger enrollees would make up only a quarter of the exchange market. Premiums would fall 2.5 percent short of covering subscribers.
Wow. If these numbers are accurate, the widespread assumption (particularly among happy Republicans) that there’s nothing ahead for exchange enrollees beyond “sticker shock” forever could give way to the expectation that Obamacare will eventually be self-stabilizing, at least for most enrollees. That in turn would upset GOP calculations that they can perpetually benefit from Obamacare’s problems without coming up with their own credible “replacement” proposal (the ones we’ve seen so far, which rely on destructive gimmicks like interstate insurance sales and state-run high-risk pools, while vastly disrupting employer-based coverage, just aren’t credible once you get beyond the slogans).
A whole lot of GOP strategery for 2014 and 2016 depends on an Obamacare crash. They might want to start seriously considering a Plan B that isn’t even worse than the pre-Obamacare status quo ante.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 18, 2013
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