“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
“The ‘Wingnut Hole’ Measured”: 5 Million Without Insurance Thanks To GOP Refusal
Because of the decision on Obamacare by the Supreme Court, which left the decision to expand Medicaid (a key part of Obamacare) up to the individual states, most Republican-controlled states refused said expansion, leaving substantial portions of the citizenry in the lurch.
Ed Kilgore has been calling this the “wingnut hole,” and many have been speculating about its size. How many Americans will go without health insurance simply because the GOP dislikes the president? Well, happy 2014, dear readers: initial estimates are in, and we have 5 million lucky winners!
About 5 million people will be without health care next year that they would have gotten simply if they lived somewhere else in America. . . . The court effectively left it up to states to decide whether to open Medicaid, the federal-state program for the poor and disabled, to more people, primarily poor working adults without children. . . .
Twenty-five states declined. That leaves 4.8 million people in those states without the health care coverage that their peers elsewhere are getting through the expansion of Medicaid, according to a Kaiser Family Foundation estimate. More than one-fifth of them live in Texas alone, Kaiser’s analysis found.
That’s approximately the combined population of Delaware, Vermont, the District of Columbia, North Dakota, South Dakota, Wyoming and Alaska. Or alternatively, either Alabama, South Carolina, Colorado or the whole of Norway alone.
The Supreme Court decision was doubly unfortunate, because Republican states tend to be poorer than average and contain a disproportionate number of potential beneficiaries who are losing out. Obamacare, by virtue of distributing benefits downward, was aimed at those very people; it never occurred to the law’s architects that the vagaries of politics and law might give states a way out, and so they didn’t design a backup coverage mechanism.
Some refusenik states, like Iowa, might go forward with an Obamacare-instead-of-Medicaid expansion, but most probably will do nothing. Prospects are bad enough that health-care industry groups have basically given up trying to push through the expansion by lobbying and are just biding their time until conditions are more favorable.
It’s worth remembering that the federal government will pay 100 percent of the cost of the Medicaid expansion through 2016 and 90 percent of the cost afterward. It could very well work out that refusenik states will not even save money because of additional spending on the uninsured in emergency rooms and elsewhere.
But regardless of the pitiful sums involved, make no mistake: This action is utterly gratuitous. Combined with the probable coming Republican refusal to extend unemployment benefits that George wrote about this morning, this is a particularly stiff kick in the teeth to the United States’ most vulnerable citizens to usher in the new year.
By: Ryan Cooper, 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
“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
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