Back in January of 2014, in the middle of Obamacare’s first open enrollment period, Washington Post reporter Sarah Kliff pointed out that the law has so many different goals that we needed a clearer definition of what success would like. She came up with four ways to tell whether the law is working:
- Do more people have health insurance?
- Do Americans have better access to healthcare (i.e. how easily can you use your insurance to see a doctor)?
- Are Americans getting healthier?
- Is healthcare getting more affordable?
As Obamacare approached its fifth birthday, she revisited these questions and found that, based on the information we have so far, yes, the law is working. Over 16 million more people have health insurance, most Obamacare enrollees can get an appointment within two weeks, and health cost inflation is at its lowest levels since the 1960’s (although it’s still too earlier to tell if Obamacare helped cause the spending slowdown or just coincided with it). It’s also still too early to tell if Americans are getting healthier, but as we pointed out last week, the early data is promising.
Yet opponents of the law are still claiming that it’s actually been a disaster. If you’re wondering whether they’re looking at the same facts, the answer is no. A recent piece from conservative columnist Jack Kelly illustrates how they continue to delude themselves and anyone who will listen by (1) over-emphasizing the aspects of Obamacare that didn’t go as smoothly as promised; (2) ignoring evidence that it’s working; (3) predicting future disasters based on little evidence; and (4) making stuff up.
1. Over-emphasizing the parts of Obamacare that didn’t go smoothly
KELLY: Tens of thousands — chiefly seniors enrolled in Medicare Advantage — have learned they can’t [keep their doctors]. Only 32 percent of 3,072 physicians surveyed by medical HR firm Jackson Coker say they’ll join the Obamacare network.”
Some Medicare Advantage (MA) plans did reduce the number of providers in their networks in response to Obamacare. However, there are over 40 million seniors enrolled in Medicare, so even if “tens of thousands” lost access to their doctor, that’s just 0.1% or 0.2% of enrollees. But seniors who find that their doctor is now out-of-network can simply move to a different MA plan or traditional Medicare. Consumer advocates recommend that seniors shop around every year anyways, since MA plans often change significantly for reasons that have nothing to do with Obamacare.
As for that survey Kelly mentions, it was done from November 8th to 12th, 2013, when the healthcare.gov website was still unusable and no one knew when, or if, it would be fixed– it was guaranteed to get a negative response. A later poll found that as of April 2014, 76.5% of doctors who are part of medical groups accept Obamacare plans, and of those who don’t, nearly half said it’s because they simply weren’t asked to participate in a marketplace plan.
“Hundreds of thousands — most recently in Colorado — have had their plans canceled. Up to 20 million eventually might, the Congressional Budget Office once estimated.”
Here, Kelly points to an actual shortcoming of the law, but again presents the numbers out of context to make it seem like a much larger problem. It’s estimated that 2.6 million cancelation letters went out, and after the White House said that states could choose to grandfather pre-Obamacare plans, fewer than 1 million plans actually were canceled. In a country of 319 million people, that’s less than 1% of the population who didn’t get to keep their plans.
As for that CBO report, it was looking at how many people would have employer-based coverage under Obamacare compared to the old system, and provided a wide range of estimates. Another estimate from that same report is that 3 million more people will have employer-based coverage under Obamacare.
The CBO says it’s most likely that around 3 to 5 million fewer people will have employer-based plans. More interesting is why the CBO believes some employers will choose to stop providing health coverage: their employees can get a better deal elsewhere.
“The businesses that choose not to offer coverage as a result of the ACA will tend to be smaller employers and employers with predominantly lower-wage workers; those workers and their families are more likely to be eligible for Medicaid, CHIP, or subsidies through the health insurance exchanges.”
“Premiums in the non-group marketplace were 24.4 percent higher last year than they would have been absent Obamacare, said the National Bureau of Economic Research.”
Yes, base premiums are higher on the individual marketplace… because the coverage is better. To give an example: under Obamacare, the maximum out-of-pocket is $6,350 and plans have to cover certain essential benefits. In Ohio, one plan being sold before Obamacare had a $13,000 deductible, and didn’t cover maternity, vision, mental health, prescription drugs, or any office visits aside from physicals. Another plan had a $25,000 deductible.
Coverage in 2014 was also more expensive because people with pre-existing conditions could now buy it– if your insurance plan refuses to cover sick people, of course it’s going to be cheaper.
Meanwhile, Kelly ignores the fact that most people buying coverage on the exchanges qualify for subsidies, bringing what the average family pays toward the premium way down.
2. Ignoring overwhelming evidence that it is working
“No wonder the law’s defenders strive frantically to move the goalposts. Obamacare is a success because more people have health insurance, they say. You have to pay a fine if you don’t have insurance, so this ‘accomplishment’ is pretty lame.”
Saying that defenders of the law are “moving the goalposts” when they point to how many more people have insurance now is just silly– it was the biggest goal of the law.
Also, the actual numbers are pretty important here. The fine for 2014 was $95 per individual or 1% of your income. It’s hard to argue that 16.4 million uninsured people signed up for coverage solely to avoid paying such a small fine, so Kelly just leaves these figures out.
“Many of the 11.4 million Obamacare ‘signups’ of which the administration boasts previously had health insurance.”
According to a Kaiser survey, more than half the signups on the marketplace last year were previously uninsured, and most of this previously uninsured group had been without coverage for two years or more. Also, many of the people who were “covered” before Obamacare had such skimpy plans that they barely qualified as insurance, like the Ohio plans we mentioned or “mini-med” plans with a maximum annual benefit of just a few thousand dollars– less than the cost of a single ER visit.
3. Predicting that the future will be terrible based on little evidence
“Obamacare’s true cost is disguised by subsidies for insurance companies due to expire in 2017, writes Stephen Parente, professor of health finance at the University of Minnesota. When they do, premiums for “Bronze” plans will soar as much as 45 percent.”
Yes, Stephen Parente (who by the way was a healthcare adviser to John McCain’s presidential campaign) thinks premiums will increase in 2017. He’s also probably wrong.
To understand why, you need to understand why the government provided extra subsidies for insurers in the first place. Obamacare is a totally new system for most insurers, so there was a lot of guesswork involved when they set their premiums. Congress wanted to keep insurers from playing it too safe and either sitting out of the marketplace in the early years or setting premiums unusually high, so Obamacare says the government will cover some of an insurer’s losses if it sets premiums too low. Parente thinks that when these programs expire in 2017, premiums will spike. However, as Adam Linker, a health policy analyst at the North Carolina Justice Center, explains:
The problem with this argument is that the particulars of the programs were not fleshed out enough to cause insurance companies to set premiums artificially low. Regulations for these safeguards came late and insurers were unsure that they would make any difference at all. In other words, insurance companies did not lowball premiums in anticipation of a big payout from taxpayers; there’s no need for a spike.
“Obamacare clobbers employment, say businesses surveyed by Federal Reserve banks in New York and Philadelphia. When the oft-delayed employer mandate finally kicks in, thousands more will lose their jobs.”
It’s hard to take seriously the claim that Obamacare “clobbers” employment, when last year– the year the exchanges were launched– was the biggest year of job creation in over a decade.
As for what happens when the “oft-delayed employer mandate” kicks in: keep in mind that it only applies to large employers (those with more than 50 employees) and between 94 and 98% of large employers already provide health coverage to full-time employees. And if conservatives are really worried about the employer mandate’s effect on employment, they’re welcome to get rid of it (if they can figure out a way to pay for it)- something we suggested a year ago.
“‘There’s no way we can afford it,’ said author Stephen Brill.”
We wrote a whole post on why we think Brill is wrong about this.
4. Making things up
“‘I will not sign a plan that adds one dime to our deficits,’ the president said. (Obamacare will raise net federal costs by $1.35 trillion over the next decade, CBO estimated in January.)”
This is the most blatantly misleading statement in the article. Kelly mentions the $1.35 trillion in costs right after the president’s line about deficits, implying that Obamacare raises the deficit. What he fails to mention is that Obamacare more than pays for those costs, reducing the deficit.
“CBO predicted when Obamacare was passed that this year 26 million more Americans would have health insurance. This month, CBO scaled that estimate back by more than 10 million, though one reason is that 23 states chose not to expand Medicaid.”
We haven’t been able to find anything where the CBO predicted that 26 million Americans be covered after Obamacare’s first year. What we did find was a report from 2012 after the Supreme Court decision made the Medicaid expansion optional; it said that the number of uninsured would drop by 14 million (and not 18 million, which is what it had predicted before the decision) in 2014. And again, the Department of Health and Human Services reports that the number of uninsured fell by 16.4 million in 2014– so Obamacare actually beat the CBO’s estimate.
By the end of the decade the CBO currently predicts 27 million fewer people are expected to be uninsured as a result of Obamacare, slightly lower than its post-decision estimate of 30 million, but still a huge drop.
“Only 6.7 million of the 8 million “signups” claimed for last year actually enrolled.”
Again, I’m not sure where Kelly got his statistics. I do know that ACA signups Charles Gaba, who has been tracking this stuff as closely as anyone, found that as of November of last year (before the start of this year’s open enrollment), 9.7 million people enrolled in marketplace plans over the course of the year and 8.5 million had paid their first month’s premium– a nearly 90% payment rate.
“Premiums will rise about 8.5 percent this year and next, CBO estimates. In the two years before Obamacare was enacted, premiums rose just 0.6 percent and 1.3 percent.”
Once again, not sure where he’s getting these numbers from. Here’s what we do know:
- In the years before Obamacare was passed (in 2010), premiums on the individual market rose 10% or more each year.
- A recent analysis from the Kaiser Family Foundation found that in 2015, the price of the benchmark silver plan increased just 2%, and the price of the lowest cost bronze plan increased just 4%.
- In some areas premiums actually decreased, which, as Kaiser’s Larry Levitt tweeted, is practically unheard of:
Competition driving ACA benchmark premiums down in many places. In health care, it’s like defying the law of physics. http://t.co/OJPrYIGOzG
— Larry Levitt (@larry_levitt) September 5, 2014
- The CBO just revised its cost estimate for Obamacare downward, largely because of, in their words, “a downward revision in projected growth in premiums for private health insurance.”
“Obamacare will cost some $50,000 for each additional person insured, according to some calculations.”
That “some calculations” part sure is vague, and with good reason: the website Politifact already looked into this claim back in January and explained how it’s clearly false. Although really all you need to do is think about it for half a second to see that the math doesn’t work– even the most expensive plans on the exchanges cost nowhere near $50,000 per person.
The one claim that is true
“Obamacare has been underwater in 200 consecutive polls, by larger margins since implementation began.”
As we pointed out earlier, just because public opinion is split doesn’t mean Obamacare isn’t working. In that post we proposed a couple theories for why the law isn’t more popular, but Kelly’s column points to one that we left out: people like Jack Kelly intentionally lying about it. New York magazine’s Jonathan Chait put it well when he looked at another conservative pundit’s bogus claims about Obamacare failing:
“It is telling that, having lost every substantive argument about the law’s operation, their sole remaining refuge is an argument about its perception. It’s true: Their lies got halfway around the world before the truth could get its pants on. Indeed, if you google most of the factual disputes I discuss above, you’ll get a lot more hits from conservatives making hysterical and false predictions than you will find from reports showing those predictions failed to come true. Those myths still hold enormous sway over public opinion. Far more Americans believe Obamacare has death panels, which is false, than believe its costs have come in under projections, which is true. Conservatives have won the propaganda war over Obamacare. The trouble is that they think this is an indictment of Obamacare, when in fact it’s an indictment of them.”