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Politics : American Presidential Politics and foreign affairs -- Ignore unavailable to you. Want to Upgrade?

To: DuckTapeSunroof who wrote (69883)	4/7/2014 1:31:57 PM
From: TimF	1 Recommendation Recommended By FJB Read Replies (1) \| Respond to of 71588

Obamacare's Bogus Enrollment Claims The program has failed in extending coverage to the uninsured. Shikha Dalmia \| April 4, 2014 Despite the last-minute fiasco of the federal Obamacare website’s shutting down before the Monday sign-up deadline, Barack Obama’s administration is rejoicing that the program met its original enrollment target of seven million people. "No one expected us to come back from the brink … but we have," gushed White House spokesman Jay Carney But Americans don’t seem to be sharing the administration’s enthusiasm: Support for the law hit new lows last week. So why are Americans enrolling with such a heavy heart? Namely because the Affordable Care Act has created more losers than winners. President Bill Clinton famously predicted that Obamacare would start getting popular the day after it was signed. But an Associated Press/GfK poll last week found that support for the law has dropped 13 percentage points since 2010. Only 26 percent of Americans now say they favor it, compared with 39 percent then. Similarly, a Wall Street Journal/NBC poll a few weeks ago revealed that only 29 percent of independents support the law. The administration blames this on misleading attacks funded by deep-pocketed conservative groups. The Washington Post’s Wonkblog has accused Republicans of trying to build a “national narrative populated only with wrenching horror stories.” But if Americans are buying Republican horror stories over the administration’s hype, that’s because those comport more with their experience. Obamacare promised to cut the ranks of the uninsured and offer those already covered a better deal while bending the cost curve. Such rosy predictions, however, are not panning out. The Congressional Budget Office (CBO) projected in February that the ACA would slash the nation’s 48 million–strong uninsured population by 13 million. (This was scaled back from its previous projection of 19 million, as The Washington Examiner’s Philip Klein notes.) But the ACA is not close to hitting even that more-modest target. Consider how its three main mechanisms for extending coverage have fared. First off, the exchanges: The seven million enrollment figure that the administration is bandying about is misleading. The actual number of uninsured covered by the marketplace will be much smaller. For starters, if the current trend continues, 20 percent of the seven million will drop out without paying. Out of the remaining 5.6 million, only about half were likely previously uninsured. Why? Because reliable early surveys found that a whopping 65 to 90 percent of those flocking to the exchange already had insurance. Even assuming that uninsured people were waiting until the end to sign up, it is hard to see how that figure would exceed 50 percent, given that six out of 10 uninsured people surveyed by the Kaiser Family Foundation recently didn’t know about the March 31 deadline and after being told about it, half of them still planned to remain uninsured. Second, Medicaid. The administration claims that the ACA’s expansion of Medicaid has allowed four million to 4.5 million uninsured people to gain coverage. But a substantial portion of that stems from regular Medicaid growth (unrelated to Obamacare). In January, Real Clear Politics’ Sean Trende estimated the number to be closer to 400,000, although he expected things to improve as the sign-up deadline approached. And last month, Avalere, a health advisory company, put the new enrollees due to Obamacare at 2.4 million to 3.5 million. (Some states are reporting higher rates of uninsured Medicaid enrollment, but it is unclear how representative or reliable they are or how many of these uninsured might have been covered even under the old eligibility criteria.) Third, the provision that allows 26-year-olds to stay on their parents’ plans. The administration claims that this provision has extended coverage to three million young people. But that’s a false assumption, given that at least some portion of them are college students with university coverage or self-employed with insurance from the individual market. Forbes’ Avik Roy estimates that the real figure is closer to 890,000, meaning that the administration’s figure represents an over 200 percent exaggeration. All of this adds up to less than seven million uninsured being covered by Obamacare, which means that the program fell 46 percent short of CBO’s 13 million mark. However, even that overstates the ACA’s success in tackling the uninsured if you consider all the people who have lost coverage. Among the ACA’s first acts was to abolish almost five million so-called junk plans in the individual market — plans that didn’t meet its standards. The administration backed off for a year after a massive outcry. But it was too late for most insurance companies to restore them. In addition, many large employers such as Target, Home Depot and Walmart have dumped coverage for tens of thousands of part-time workers. These insurance refugees constitute at least half the people buying coverage from the Obamacare exchanges. But if they don’t qualify for subsidies, they face higher out-of-pocket costs for plans that cover things they don’t need and leave out things they do. For example, the Los Angeles Times found last year that middle-income consumers in California face an estimated 30 percent rate increase in their insurance bills “due to several factors tied to the health care law.” Such factors include limitless lifetime coverage and many benefits such as hair prosthetics for cancer patients that many people don’t care about. But what patients do care about — their choice of doctors and hospitals — they can’t get because that would further bump up premiums. (The usually excitable Ann Coulter wrote a sobering account of her difficulty in finding her choice of providers under even the most expensive Obamacare plans here.) Nor are things likely to get better next year. That’s because the mix of the new Obamacare sign-ups is so skewed toward the old and the sick that some experts are expecting premiums to double. So, to recap: Obamacare has extended coverage to a far smaller portion of the uninsured than expected, caused millions of others to lose coverage, raised out-of-pocket costs for many middle-income consumers, diminished patient choice of doctors and hospitals and exposed Americans to future premium hikes. This is why Americans are not popping the cork. Nor should the administration. reason.com

To: DuckTapeSunroof who wrote (69883)	4/9/2014 1:59:35 PM
From: TimF	Read Replies (1) \| Respond to of 71588

RAND Comes Clean: Obamacare's Exchanges Enrolled Only 1.4 Million Previously Uninsured Individuals <!-- --> Avik Roy, Forbes Staff Last week, I wrote about an article in the Los Angeles Times, on a then-as-yet unpublished report from the RAND Corporation. The report indicated that only one-third of Obamacare’s purported 7.1 million exchange sign-ups were from the previously uninsured. But Noam Levey, the author of the Times article, didn’t disclose RAND’s actual findings as to the actual number of previously uninsured exchange enrollees. Well, now we know why. RAND published the full report yesterday; it indicates that Obamacare’s exchanges only enrolled 1.4 million previously uninsured individuals. That 1.4 million is out of a total of 3.9 million exchange enrollees overall. That is to say, a little over a third of enrollees—36 percent—were previously uninsured. RAND’s figures don’t take into account the last few weeks of the Obamacare open enrollment period, and they contain a substantial margin of error, due to the study’s small sample size. (RAND surveyed 2,425 individuals aged 18 to 64; the 1.4 million figure has a margin of error of 700,000, meaning that there is a 95 percent probability that the actual number is between 700,000 and 2.1 million previously uninsured enrollees.) If you assume that 80 percent of signer-uppers will eventually pay their premiums, the true number of previously uninsured exchange enrollees is likely closer to 2 million. That’s far from what the Congressional Budget Office has projected; the CBO estimated that 80 to 90 percent of the first-year enrollees would come from the previously uninsured population. Instead, it appears to be more like 24 to 36 percent. Because the RAND survey is quite small—a comparable survey by the U.S. Census Bureau surveys around 250,000 individuals—its results aren’t as reliable. But the RAND authors, Katherine Grace Carman and Christine Eibner, perform a useful service, because they break out how people of varying insurance statuses in 2013 fared in 2014. For example, of the 40.7 million people they consider to have been uninsured in 2013, RAND can break out the fraction of those who gained insurance via the exchanges, via Medicaid, via employer-sponsored insurance, et al. RAND finds that, overall, 9.3 million more U.S. residents have health insurance in 2014 relative to 2013. That figure has a margin of error of 3.5 million. But that’s not the interesting part. The interesting part is that 8.2 million of that comes from growth in employer-sponsored insurance. Labor force participation has been steadily declining, especially among younger individuals, which would seemingly make this result unlikely. Other surveys from ADP and Aon Hewitt have found that employer-sponsored coverage among the young has been flat to down. On the other hand, it’s theoretically possible that Obamacare’s individual and employer mandates have convinced millions of Americans to sign up for health insurance. But those mandates have been repeatedly delayed and laced with loopholes and exceptions. A third possibility is that RAND’s survey is simply inaccurate. The authors note that “people may not report having Medicaid because their state uses a different name for the program or because they do not understand the true source of their insurance.” We just don’t know. Notably, RAND finds that outside of employer-sponsored insurance, Obamacare’s impact on the uninsured has been minimal thus far—a net of 1.1 million between Medicaid (+5.9 million), the exchanges (+3.9 million), off-exchange individually-purchased insurance (-1.6 million), and other forms of insurance, such as coverage for federal employees and the military (-7.1 million). It’s hard to know what to make of these findings. On the one hand, it’s concerning that many people have lost other kinds of insurance and gone onto Medicaid. On the other hand, many people appear to have moved onto higher-quality, employer-sponsored plans. It’ll be interesting to see if others can replicate the finding that Obamacare is increasing the number of people with employer-sponsored insurance. If they can’t, then we’re left with underwhelming enrollment figures on the exchanges. Given all the media noise around the allegedly magical 7.1 million exchange sign-up figure, it’s worth pausing to note that it’s not at all clear how successful the exchanges have been at attracting the uninsured. * * * UPDATE: Ross Douthat, on Twitter, points out that the weird RAND spike in employer-sponsored coverage could be explained by the fact that the survey compares March 2014 enrollment statistics to those of September 2013: If RAND had compared March 2014 to March 2013, they might have gotten a different result. forbes.com