They say we don’t talk to people on the other side often enough. That usually we talk past each other, tossing straw men filled with straw arguments back and forth.
That only changes when we stop and look seriously at the arguments presented by the other side and slowly, patiently rebut them point by point or have the courage to admit when and where their points are actually valid. Today I will attempt to do exactly that as the time rapidly approaches where the current White House resident and his cabal in congress will very likely vote to repeal the health care of nearly 30 million Americans.
If we’re going to have this argument, we should at least be fully prepared for it.
So without further fanfare, here we go.
The obvious problem with this is that it doesn’t compare the current increase in costs today to what they had been in the years prior to Obamacare. Yes, healthcare costs rise, they almost always rise — that’s called inflation. Almost nothing goes down in price unless we have a large increase in the available supply and/or a decrease in demand. If people were to stop getting sick, we might see healthcare costs go down, but frankly that has almost never happened.
As the above chart from the Obama White House shows, employer based costs between 2000-2010 the years prior to implementation of the ACA, were considerably higher than they are now. The growth rate following passage of the ACA according to the same Kaiser Foundation cited by Heritage has been 40 percent lower than it had been the previous decade.
So yeah, prices are rising, but not nearly as quickly as they did before. This is not a small deal. The life of the Medicare trust fund was actually increased by the ACA because of the reduction in costs.
And lastly, where costs have gone up for people purchasing insurance on the exchange so have subsidies for those that can qualify for them. I would agree that there should be some adjustments for small business who are been forced into other markets or perhaps widen the qualifications for subsidies for those who’ve seen some one-time high price spikes, but for each of these problems many other millions have gained care they couldn’t otherwise access or afford.
Contrary to Paul Ryan’s view there were High-Risk pools in place before the exchanges came on board and those were far, far more expensive and less flexible than what is available now. High Risk pools via Kaiser.
So the argument that ACA is by definition all bad and super expensive while High Risk pools are some type of viable improvement has already been proven false by past experience. Yes, segregating the sick into high risk pools might bring down costs by possibly as much as 50% for those outside the pool, but for those in the pool prices would skyrocket while services would plummet.
This is actually a true point. Relative to when the law started there are fewer insurance providers in some markets, but again this is the wrong comparison. Prior to the ACA there were no providers available for people with pre-existing conditions in the individual market at an affordable price. It’s valid to point out that the exchange isn’t a massively profitable market for some providers, but then it’s not intended to be a cash cow, it’s intended to be a way that some people can get care that they couldn’t previously get.
Effects of the Legislation on Insurance Coverage
CBO and JCT estimate that by 2019, the combined effect of enacting H.R. 3590 and the reconciliation proposal would be to reduce the number of nonelderly people who are uninsured by about 32 million, leaving about 23 million nonelderly residents uninsured (about one-third of whom would be unauthorized immigrants). Under the legislation, the share of legal nonelderly residents with insurance coverage would rise from about 83 percent currently to about 94 percent.
Approximately 24 million people would purchase their own coverage through the new insurance exchanges, and there would be roughly 16 million more enrollees in Medicaid and the Children’s Health Insurance Program than the number projected under current law. Relative to currently projected levels, the number of people purchasing individual coverage outside the exchanges would decline by about 5 million.
This was a ten year projection going out to 2019 and their estimate was 24 Million, not 21 Million so we’re not really in a apple/apples comparison. But then again, not every state implemented their own individual exchange or expanded Medicaid as they were supposed to as the Kaiser Foundation points out.
We find that if the 21 states that have not expanded Medicaid as of April 2015 were to do so:
- The number of nonelderly people enrolled in Medicaid would increase by nearly 7 million, or 40 percent.
- 4.3 million fewer people would be uninsured.
- There would be $472 billion more federal Medicaid spending from 2015 to 2024.
- States would spend $38 billion more on Medicaid from 2015 to 2024.
- Savings on reduced uncompensated care would offset between 13 and 25 percent of that additional state spending.
- States would be able to realize other types of budgetary savings if they expanded Medicaid that are not included in this report.
Things didn’t go according to plan, but even with these curveballs 13 Million are people covered via the exchanges with another 10 Million covered in the Medicare expansion. This could be even more, but contrary to Heritage’s implication the program isn’t facing any time of imminent collapse from lack of participation. It’s growing, not shrinking.
Those who didn’t sign up with the exchanges or Medicaid either had employee healthcare or simply decided to go without and paid the penalty. That’s not a bad thing, that was part of the plan.
Also some of those tax exemptions include a 50% tax credit for small business who purchase insurance through an exchange. Again, not a bad thing.
6. The exchange websites were not a “Failure”, their initial problems were fixed in the first month.
4) Exchange Websites
The federal government sent nearly $5 billion to states to set up their own health insurance exchanges. Despite the ample funding, the vast majority of states either didn’t want to set up their own, or tried and failed.
11 States made their own exchange websites. The plan was for all 50 to do their own but partisan politics prevented that and a Federal site had to pick up the slack.
It was rough going for about a month, but the site problems were quickly fixed. Following the 2016 election 670,000 people signed up for ACA coverage in a single month. That doesn’t happen with a site that doesn’t work.
7. Old plans were allowed and “grandfathered” under Obamacare, they just weren’t mandated to continue, insurance companies killed them to get higher premiums, not O-care.
5) If You Like Your Plan, but the Government Doesn’t, You Can’t Keep It
When Obamacare’s insurance rules and mandates took full effect in 2014, insurers were forced to cancel existing plans that didn’t comply with the new standards. A tally put together by the Associated Press shows that there were at least 4.7 million plan cancelations across 30 states.
This is perhaps the most egregious misrepresentation of the lot. The type of plans that existed prior to the ACA were allowed to continue, they were grandfathered and protected under the ACA — they just weren’t forced to remain in place. Insurance companies themselves made the choice, and sometimes they chose to upsell a newer plan rather than retain an old one.
Some insurers were even fined as much as $65,000 for this practice.
The Kentucky Department of Insurance has fined Humana $65,430 because it offered policyholders an unapproved opportunity to amend their insurance as part of a letter that regulators have called “misleading.” The department investigated letters sent in August to 6,543 individual plan policyholders in Kentucky. The letters said they needed to renew their plans for 2014 within 30 days or choose a more expensive option that complies with the Affordable Care Act. But regulators last month called the letters misleading, arguing they did not make sufficiently clear that policyholders could compare and choose competing plans on the state’s health insurance exchanges, which open on Oct. 1, and for which they could be eligible for federal subsidies.
Grandfathered plans didn’t have to cover pre-existing conditions, or provide free preventive care. High deductibles and Copays which are capped under the ACA’s full requirements could remain and the yearly spending cap could continue for those plans in the individual market.
The argument that ACA prevented these plans from continuing is simply false, but it also didn’t require them to continue if the insurance company wanted to change it’s plan offerings. For every plan they discontinued another had to be offered in it’s place, so the claim that millions “lost their plan” and consequently their coverages is untrue, their plan was changed and replaced by the free choice of their insurer, not the ACA— but they didn’t lose all coverage.
8. The Co-Op program was always intended only as an excuse to avoid Single-Payer, the Public Option or Medicare-For-All.
6) Collapsed Co-Op Program
Obamacare provided for the creation of 23 new nonprofit health insurers through the Consumer Operated and Oriented Plan program. These insurers launched in 2014, using $2.4 billion in taxpayer-funded “loans.” Shortly thereafter, they began to collapse like dominos.
Again, this is another half-truth. The Co-Op program has not expanded much. but again there were partisan reasons behind some of this.
Heritage ignores the fact the the Co-Op program was only added as a diversion from including a Public Option within the plan. It was a half-measure, just as was the Multi-State plan option which were also provided in place of a public option and has only been half successful. Conservatives are constantly saying “buying insurance across state lines” is the magic panacea that will fix everything, well that already exists.
The Multi-State Plan (MSP) Program, established under the Affordable Care Act, directs OPM to contract with private health insurers in each State to offer high-quality, affordable health insurance options called Multi-State Plans. MSP coverage is offered through the Health Insurance Marketplace, where financial assistance is available to those who qualify.
As of right now insurers are only offering these plans in 24 states so it’s not exactly setting the insurance world on fire. At any rate neither of these are cornerstones of the overall ACA, they’re side dishes.
9. Medicaid is not a “Dumping Ground” — it’s saved lives and money.
7) Dumping Millions Into Medicaid
Instead of reforming the over-stretched and unsustainable Medicaid program, Obamacare has dumped millions more people into it. After the first two years of Obamacare, an additional 11.8 million people were enrolled in the Medicaid program.
The law’s expansion is projected to add $969 billion in new Medicaid spending over the next decade, adding to existing Medicaid spending for a total federal cost of $3.8 trillion from 2017-2028.
Adding more people into Medicaid has not been a bad thing. In fact, it’s saved money for many of the states that did expand the program.
Medicaid expansion has given a budget boost to participating states, mostly by allowing them to use federal money instead of state dollars to care for pregnant women, inmates, and people with mental illness, disabilities, HIV/AIDS, and breast and cervical cancer, according to two new reports.
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The RWJ report examined eight Medicaid expansion states: Arkansas, Colorado, Kentucky, Michigan, New Mexico, Oregon, Washington and West Virginia. It found that those states, selected for their regional and demographic diversity, will save (or collect) a total of $1.8 billion through Medicaid expansion by the end of 2015.
“I don’t know any other way of describing it except as a win-win for us,” said Audrey Tayse Haynes, secretary of the Kentucky Cabinet for Health and Family Services, which expects to have saved nearly $109 million by July 1.
It also has the added benefit that more people have healthcare in those states.
10. “Restricted Access” to providers is still an improvement over zero access to consitant preventive care.
8) Restricted Access to Providers
Obamacare’s increased costs have prompted narrow network plans to flourish on the exchanges—an unpleasant surprise for patients that desire broad access to providers. The Robert Wood Johnson Foundation measured network size for plans sold in the 2014 exchanges, finding
Fourty-one percent of networks are small or x-small: 11 percent of networks are x-small, meaning they include less than 10 percent of office-based practicing physicians in the area and another 30 percent are small, including between 10 percent and 25 percent of physicians. At the other end of the spectrum, 11 percent are x-large, which we define as networks including more than 60 percent of physicians.
This is basically a repeat of complaint #2 under “Choice and Competition.” Providers are free to participate or not, they do have some incentives, but generally it’s up to them. Perhaps more flexibility should be allowed at the State level to increase or modify those incentives in the risk corridor but again, the point here is providing care that pretty much didn’t exist for millions of people at any reasonable price.
11. Approximately 6,500 per year would have died due to lack of insurance, but haven’t because they had coverage via the ACA.
Nowhere in their piece does Heritage consider any of the positive effects of the ACA or the downsides of it’s repeal. The primary benefit of course, is that more people are healthy.
A few recent studies suggest that people have become less likely to have medical debt or to postpone care because of cost. They are also more likely to have a regular doctor and to be getting preventive health services like vaccines and cancer screenings. A new study, published Monday in JAMA Internal Medicine, offers another way of looking at the issue. Low-income people in Arkansas and Kentucky, which expanded Medicaid insurance to everyone below a certain income threshold, appear to be healthier than their peers in Texas, which did not expand.
The study took advantage of what Dr. Benjamin Sommers, an author of the paper and an assistant professor of health policy and economics at Harvard, called “a huge natural experiment.”
And then there’s fact that people without insurance, have a far higher mortality rate.
A 2012 familiesUSA study shows that more than 130,000 Americans died between 2005 and 2010 because of their lack of health insurance. The number of deaths due to a lack of coverage averaged three per hour and that the issue plagued every state. Other studies have shown those statistics to be high or low, but all studies agree: In America the uninsured are more likely to die than those with insurance.
The uninsured:
- are less likely to have a usual source of care outside of the emergency room
- often go without screenings and preventive care
- often delay or go without needed medical care
- pay more for medical care
Under the ACA (ObamaCare) as of March 2015 about 25% (rough estimate based on enrollment numbers and other polls) who were previously uninsured are now covered. This means that, unless subsidies are made illegal by King V. Burwell, or more changes like states opting out of Medicaid expansion occur, deaths due to lack of health insurance should dramatically decrease by the time the ACA is in full effect by 2025. An estimated 31 million non-elderly Americans of the 40 million uninsured are expected to be insured by 2025. See the Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, January 2015.
If we do the math 25% of 130,000 over five years is 6,500 people per year who would have likely died due to being uninsured, but probably won’t due to the ACA.
Surprisingly one of the issues they didn’t bring up is the individual mandate. Imagine that.
The idea that Health Savings Accounts and/or Tort Reform will bring health insurance to the 30 Million who gained it via the ACA is just plain laughable. In what country on earth have any of those “market based” ideas been successful at expanding care and controlling heath care costs? Where’s the test case that proves that theory? The fact is that every other advanced nation on the planet has some type of single-payer or public plan, and most have costs that are half of ours with better results.
It’s fair to complain about some of the limitations and shortcomings of the law, clearly there is room for improvement in various areas. But the fact is that it is actually making people healthier on the average and is potentially saving lives which could be put at great risk under repeal particularly if there is no replacement for the challenges they face. And, on the whole, it’s saving money, has extended the life of Medicare and is saving states money on their Medicaid expenditures.
This is not a law that deserves to be repealed, it deserves to be extended and strengthened. Period.
Saturday, Feb 4, 2017 · 4:06:47 PM +00:00 · Frank Vyan Walton
One more thing on point #5, as Charles Gaba noted — and he had his own tweet responses to all 8 reasons after I sent him the link — that “this was true for a week… then an extension was granted” is correct. The requirement for new plans to meet the ACA ten essential requirements only lasted for a week, then the requirement was pushed back another year. So again, insurance companies had no valid reason linked to the ACA for canceling and replacing those plans. They just did it because they wanted to, not because the ACA made them.