Volume 6: Health Insurance, Part III


Obamacare: The Long War

“I’m not on Obamacare. My health insurance is through the ACA.” – Twitter, various

Almost seven years after its passage, the Affordable Care Act hasn’t become any less controversial. Historically, after they are passed, most pieces of legislation “settle down” into implementation mode as even opponents try to make the law work as well as possible. Not so here – from the day of its passage, its opponents have tried to dismantle the so-called “disaster”, while its proponents have refused to consider going back.

How do we best consider the effects of this complex law? Rather than making value judgments about how our health insurance system should work, let’s judge the ACA by the terms of its debate. What did its supporters predict? What did its opponents predict? Who was right? The debate over what features are present in a strong health insurance system is unlikely to end soon. But this framework should give a more neutral point of view to explain what the ACA’s effects have been.

  • What did the proponents of the ACA predict?

  • What did the opponents predict?

  • How is each side describing the current state of the health insurance system?

 

What did the proponents of the ACA predict?

Before we dive in, let’s set some ground rules. Most importantly, it would be easy to cherry-pick people on either side making crazy predictions and then shoot them down. Everything here is intended to be representative of the larger debate. For some predictions I’ll use a quote, while others have general statements.

Like my fact-checking compatriots, we’ll also need a consistent set of rulings to “rate” how everybody did. Politifact’s system seems to cover most bases. One clarification – I’ll use “Pants on Fire” only for a deliberate fabrication; an honestly made prediction that didn’t bear out is just “False”. Let’s dive in…

“If you like your plan, you can keep it." - Barack Obama

Might as well get our hands dirty right away. The President should not have made this statement – it was a promise that he had no way to keep. One of the reasons why the ACA was created was that many people with insurance were not really covered. As an extreme case, “mini-meds” were very inexpensive but had annual benefit caps as low as $2,500. Of course, some people “liked” these plans, and they were going to go away.

As discussed in previous Volumes, the ACA created various criteria, without which an insurance plan would be “non-compliant.” A significant percentage of plans on the individual marketplace lacked these conditions, and their policyholders received notification that their plan would be cancelled. While the exact number of people affected isn’t known, a good guess is that 2.5-3 million people received cancellation letters.

The White House seemed genuinely surprised by how many were affected and took action. Existing plans were grandfathered through 2017, although some providers unilaterally canceled their plans sooner (individual market plans were frequently cancelled in the pre-ACA world).

Rating: FALSE. I disagree with Politifact’s “Pants on Fire” because I think the statement was made in good faith.

Approximately 26 million people will gain coverage by 2016. - CBO

In 2012 (following the Supreme Court decision in NFIB v. Sebelius), the CBO predicted that 26 million additional net persons would be covered due to the ACA. This included:

  • 10 million additional due to Medicaid/CHIP expansion

  • 23 million additional on exchanges

  • 5 million fewer by employers

  • 2 million fewer in nongroup (i.e. individual) market

This would leave an uninsured non-elderly population of 30 million.

To see how this compares with the results, we can refer to the ACA Signups Healthcare Coverage Breakout. The categories don’t agree exactly with the CBO, but to get an idea:

  • Medicaid/CHIP expansion has added 14 million beneficiaries

  • Exchanges have added 11 million, but there are also 7 million off-exchange policies

I’m not able to make a good comparison on the nongroup or employer section with the data I have. However, with total uninsured at 29 million, the total change is in line with the CBO prediction.

Rating: TRUE. The mixture is off, but the overall number is dead on. It looks like fewer people than expected left their employer sponsored plan.

“I will not sign a plan that adds one dime to our deficits – either now or in the future.” - Barack Obama

With the caveat th