Posted on 04/19/2014 10:55:56 AM PDT by SeekAndFind
It has been a triumphant month for liberal journalists who have lived and died with the fortunes of the Affordable Care Act since its passage in March 2010. Ezra Klein and Jon Cohen have declared victory, describing an amazing recovery for the program and for President Obama since the dark days of near-total failure among people trying to sign up on the federal exchanges in October and November.
To listen to Obamacare supporters, Kathleen Sebelius leaves her post as secretary of the Department of Health and Human Services with her head held high, as her legacy now includes shepherding across the finish line a major expansion of health insurance for low-income, previously uninsured Americans. Howard Dean says [1] the Republicans would be foolish to attack Obamacare in this year’ s campaign, now that the program has achieved so much success
Carl Sagan spoke [2] of “billions and trillions”; now the president and the Obamacare support media can talk of millions and millions newly insured.
But how many millions?
Prior to the opening of the exchanges in October 2013, President Obama claimed that the ability of families to keep children on their health insurance policies through age 26 had already added three million people to the ranks of the insured. This claim appears to be nonsense. Avik Roy — one of the few journalists who has actually been examining the data and drawing his own conclusions rather than regurgitating or looking to justify each of the administration’s assertions — estimates that the actual number of newly covered young people [3] is less than one-third of the number claimed, and perhaps far less.
In fact, the percentage of uninsured Americans aged 18 to 24 has not changed at all from 2008 — prior to the economic collapse — through 2013. And of course, the change in policy did not come free. Roy estimates that family plans now cost $160 to $480 a year more due to the new coverage — and that is for all families, including all those without children who are newly covered. Also, as with all the other “free things” offered on the screening side due to Obamacare, none of it is free as someone else has to pay for them.
The numbers for October 1 through the end of March — and now beyond due to late trickles from the exchanges — suggest 7.5 million people signed up on either the 16 state exchanges or the federal exchange (used by the other 34 states). Medicaid sign-ups, which can continue without any deadline during the current federal fiscal year, were 3.5 million. About half of the states did not participate in the Medicaid expansion, so any new enrollees in Medicaid in these states can not be attributed to Obamacare.
In the years 2010 to 2013 — after the act was passed but before any expansion of the program beyond those at 100% of the poverty level or below — and now, since the expansion, Medicaid enrollees have increased. If the growth in the non-expansion states is considered a proxy for the enrollment growth that would have occurred without Obamacare, then about a quarter of the Medicaid enrollment growth is “natural” and unrelated to Obamacare. That leaves about 2.5 million new Medicaid enrollees, who benefited from the expansion of the program to include those earning up to 138% of the poverty level.
Given the huge promotional push for Obamacare (some estimate a billion or more in federal, state, and corporate spending to advertise the new enrollment opportunities), it is likely that most of any surge in enrollment for Medicaid attributable to the coverage expansion has already occurred for this year. For point of reference, Medicaid enrollment grew by over 7% annually in the two years which overlapped with the economic recession, a faster growth rate [4] than the recent six-month period which included a large eligibility expansion.
If you are keeping score, we may have 3.5 million total insured by counting young people kept on their parents’ policies and the expansion of Medicaid coverage. The big whale, then, is the enrollment number for the exchanges.
The Obama administration has released a mid-April figure of 7.5 million, though they admit this is not the number of those who have paid a premium (or paid once and continued to pay).
Several insurance companies — the ones actually providing new coverage and collecting premiums — have suggested that a ratio of 80% paid to enrolled is a good estimate so far. That would mean six million paid enrollees.
In total, 9.5 million are newly insured, of which a million or so come from the family plan expansion that occurred prior to October 2013 — leaving 8.5 million newly insured since the exchanges opened. This is a number well short of the administration’s first year goal of close to 15 million new enrollees, though in fairness another 2.5 million Medicaid enrollees might have signed on had all 50 states expanded coverage, bringing the total number since October 2013 to 11 million.
Of course, previously insured people lost coverage and did not obtain new coverage. This number may not be that large. Rand Corporation [5] has estimated that a large percentage of the first few million enrollees in the exchanges had coverage before October 1, and shifted to the exchanges either to replace a cancelled policy or to obtain coverage with a generous federal subsidy to pay for it.
Of course, the subsidies are not free lunches. They are paid for with cuts to Medicare and higher taxes on a small percentage of Americans and industry groups.
A few new surveys from the last month provide numbers in line with Rand’s estimates on the number of Americans newly insured and the drop in the percentage of Americans without insurance. Gallup estimates [6]a 4% reduction in the percentage of adults without insurance. Gallup goes on to note that a disproportionate percentage of the newly insured are younger people or lower income people, who tend to vote Democratic.
The youth aspect is not surprising, since those over age 65 are already covered in almost all cases by Medicare. Obamacare did nothing for them, and made some changes to Medicare Advantage programs that will likely make this alternative more costly and less attractive to the elderly.
Of course, the political damage to Democrats for this election cycle from the Medicare Advantage program cuts [7] has been eased by one of the many program changes announced by the administration.
A major goal of the Affordable Care Act was to expand coverage through redistribution of income, taking taxes from haves to provide subsidies on the exchanges or expanded Medicaid coverage to have-nots. The legislation’s sponsors said this was a critical justification that they did not attempt to hide — “reform” meant “redistribution.”
On that score, the program seems to have achieved its goals if Gallup’s survey is accurate, and probably reinforced political positions on the wisdom of expanding big government social programs among its recipients.
For now, the administration is several million short of its first-year enrollment goal, even adjusting for the states that did not expand Medicaid. The Affordable Care Act’s backers may be right that the program numbers, whether nine million or something slightly smaller or larger, will make it much less likely that it can be legislatively dismantled.
A different threat may come from the Supreme Court. John Roberts passed on an opportunity in 2013 to kill the bill in its entirety. But the Court may get one more chance [8] to deal a partial death blow for the states that are part of the federal exchanges. Sloppy drafting of the legislation seems, on its face, to prohibit federal subsidies when states fail to set up their own exchanges and rely on the federal government to do it.
I think this challenge faces long odds. Of course, what Obamacare is today is a lot different than the bill that was passed. Several dozen changes were unilaterally adopted by the administration to delay or modify provisions so as to avoid political damage in the 2012 election and in 2014.
The administration has never seemed to share Howard Dean’s confidence that everyone now or in the future will love Obamacare. All that is clear: whatever Obamacare is at any point in time, its original supporters will race to the barricades to defend it.
“There are thirty-two ways to write a story, and I’ve used every one, but there is only one plot — things are not as they seem.” — Jim Thompson
Look closely at the words they use. Unless they say the word “insured”, it means nothing. And even then, it’s BS.
I am supposedly covered with a deductible equal to my gross income -per person!!! WTF is that??? I’m not insured, I’m screwed. But he is counting me and mine. It’s all Streisand.
I don’t understand why it even matters. So what if it’s 9 million or 7 million. People are required to sign up. It’s the law, otherwise one is fined, er...taxed. The bigger story in my opinion is that so many millions more are NOT signing up. How many commies, er...progressives, voted for Obama last election? Let me know when Obamacare enrollments equal that.
Why would anyone believe anything this government says about any subject at all?
Now, after a 3000-page law, a bogus Supreme Court decision, a $100 million web site, and a few billion dollars in spending, the feds have managed (so they say) to get 8-9 million Americans to sign up for health insurance.
And it's a big "success".
RE: Look closely at the words they use. Unless they say the word “insured”, it means nothing.
So, enrolled does not necessarily mean insured?
When can an enrollee be insured then?
the best healthcare system in the world, gutted, for this...
The left embraces Obamacare because it’s pretty much a blank check. It gives them virtually unlimited power to decide who or what is covered, and they don’t need to go back to Congress to decide. Congress simply handed the bureaucrats a blank check, much like they’ve done with so many other issues, like energy, food and drugs, education, etc.
The good thing about that is we don’t even need to repeal Obamacare to pretty much destroy it. I want it dead and gone of course, but let’s say we’re fortunate enough to win the presidency. Our president could simply say just about anything meets the minimum qualifying coverage. I’m pretty sure Obamacare really gives the president’s administration wide discretion over what is covered (correct me if I’m wrong). Implementation dates may be in black and white (and being ignored by Obama), but many other aspects are left up to the administrative state.
In many ways, it’s much like the EPA. Nothing forces them to treat CO2 as a pollutant. Progressives in the EPA took wiggle room in the law to declare CO2 a pollutant. Once again, even if we can’t destroy the EPA, we can conceivably roll back its mandates simply by changing who’s in charge. The administrative state is too powerful, but nothing forces it to do what it’s currently doing. All those rules and regulations could be scrapped by a Republican administration. Finding a Republican who would actually do it? That’s the real problem.
Words will mean whatever this administration SAY they mean.
The sooner we learn this, the sooner we’ll join all the good little drones.
It is incredible how quickly the dialogue has changed in one month. We were doing pretty well with our message and most of America was on our side with Obamacare. The last month has been a bit worrisome as the dialogue has changed to positive news and I just hope the American People are not snowed by it. They certainly have before.
And of course all of this doesn’t mean care by medical professionals, or treatments, or tests. It means (for the most part shoddy) insurance. Will this insurance translate to care and treatment? Will there actually be payment therefrom? No one knows.
It’s a failure if the 40 million uninsured aren’t insured. That was the #1 reason the rest of us had to give up our existing health care, wasn’t it? If I remember correctly, that’s what the progressives claimed. It was all about helping the uninsured. If that’s the standard, Obamacare is a dismal failure, and we’ve sacrificed our own health care freedoms for what? Nothing.
The left loves Obamacare, but not because of what it currently does. They love it because they now have a blank check to do whatever they want. They literally have authority under the law to say insurance companies must provide nutritious food or free gym memberships as part of a minimum qualifying plan. Correct me if I’m wrong, but they now have very broad discretion to pick health care winners and losers. There is virtually no aspect of health care that the federal government cannot now regulate.
RE: t’s a failure if the 40 million uninsured aren’t insured
OK, the begs the next question — where are we getting the 40 Million number from and how accurate is it?
I like what you are saying. May we get conservative leaders who destroy the control by reducing all the rules. Making progressive control completely toothless.
I don’t know where the 40 million number came from, but covering the uninsured, like those with preexisting conditions, was one of the big selling points for Obamacare. Actually, I don’t know why we even bother discussing it. The commies were lying when they passed it. They’re lying now.
The left wants nationalized health care, and anything short of that is just a means to that end. Nationalized health care is the only way to make things fair. They might even mean well, but they can’t give high quality care to everyone. All that will happen is the same thing that has happened everywhere else it was tried. Some will have more. Most will have less, and unless you have connections in the bureaucracy, you’re much more likely to be in the latter group.
According to the courts, there is virtually nothing that the federal government can’t do. All I’m saying is the power to create all these rules and regulations is the same power to destroy them, and one doesn’t even need to go back to Congress to do so! Congress has abdicated that power to the regulatory state, but nothing forces the regulatory state to do what it does beyond very general requirements and broad discretion to act. So someone like Reagan could easily dismantle it all with a stroke of a pen.
It’s not legal to add new regulations that aren’t authorized by law, but again, it’s perfectly legal to destroy regulations that aren’t specifically required by the law. Don’t want CO2 regulated as a pollutant? Gone! Again, Congress doesn’t even have to act.
It even gets better than that. Not only does Congress not have to act to eliminate all sorts of rules and regulations, but they can actually be stopped by one person—the president. It’s very difficult to override a presidential veto, and the same game being played by Obama can be played in reverse. The beauty of it is simply that in our case, it would be entirely legal for the president (and his executive branch) to dismantle the vast majority of what’s been created by Obama. The powers the left have given to the administrative state can be used against them—legally.
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