End-of-Marketplace-Open-Enrollment ObamaCare Watch: Tuesday Focus: April 1, 2014
It is worth noting, and reiterating, and reiterating again that, as Paul Krugman says, the RomneyCare exchanges are the conservative way to “universal” health insurance. If you want to preserve a robust private-sector health insurance market and if you want insurance to be affordable for all, then you need some forms of: (a) community rating, (b) subsidies, and (c) a coverage mandate. The other options are all some form of single-payer, or something that leaves a great many people unable to afford going to the doctor.
Maybe you want to disguise the single-payer nature of the program–John Kerry’s proposal by which the federal government would be the single payer for expenditures above… was it $50,000/year?… was such a disguise. But that plan met with no greater Republican enthusiasm than RomneyCare.
And if the marketplace-exchanges do turn out not to work, and if we retain the goal of affordable coverage for all, then single-payer will be our only remaining option.
Richard Mayhew: And we’re done: “Regular open enrollment in all areas of the continental United States for Exchange coverage is done. And the numbers are massive….
It looks like total enrollment excluding the people who checked the little blue box for an extra two weeks will be over 7.0 million people….Let’s make some predictions about the newest cohort of enrollees. Healthier than the February cohort and much healthier than the October/November/December cohorts… the people who know that they need coverage because they are either sick, have a long term condition needing care or believe that they are higher than typical risk of getting sick, signed up first…. Younger…. Health insurance is a lower salience issue on average for young people when compared to old farts who know that they could start breaking down. Less connected to previous systems of aid….
So what does this mean for 2015? The actuaries will be drinking way too much coffee for the next month as they try to figure out what next year’s rate structure should look like. Remember, the CBO projects twice as many people to be on the Exchange next year as they projected for this year. That population will be a bit different in key ways from the 2014 Exchange enrolled population. However, 7 million or more people on Exchange, and 9 million people with off-Exchange but PPACA compliant shared risk-pool policies means there is some good data to make some decent guesses for next year.
Noam Scheiber: The GOP’s Most Cynical Anti-Obamacare Attack Yet: “Tennessee congresswoman Marsha Blackburn.
Appearing on MSNBC this morning, Blackburn was asked whether she disputed poll numbers showing the percentage of uninsured Americans to be steadily falling. Here’s how Blackburn responded:
Well, I think what we, there again, have to do is look at what you find in those numbers. And I would direct you to the 2012 Kaiser report that said 33% of all physicians are not seeing new Medicare enrollees. Now, if we have a lot of Medicaid enrollees—excuse me, I mean Medicaid enrollees. They’re not expanding their Medicaid population in their patient base.
At which point anchor Chris Jansing rightly pointed out that Tennessee, along with several other Republican states, has refused to sign on to the very Medicaid expansion Blackburn says isn’t happening. “But you didn’t offer that in Tennessee, correct?” Jansing said. Back to you Rep. Blackburn:
Let me finish my thought here, then we’ll talk about Tennessee. What we are doing, if we are giving an insurance card to those individuals who do not have access to the doctor. Basically, it’s a false promise, because you say, “You have insurance to the queue, not to the physician.”
Now the reason there was not a Medicaid expansion in Tennessee is because we have been to this dance before. It was in the mid-‘90s, the test case for Hillarycare. It was an abysmal failure. We have Secretary Sebelius, who has called the rollout of Obamacare a debacle. That is exactly what happened in Tennessee. A debacle. The legislature has chosen not to expand Medicaid in Tennessee, and with good reason. They know it’s not an affordable premise. And they are very concerned about the impact that would have on the access to health care within our state.
So, to review: Blackburn says Obamacare is a failure because the promised Medicaid expansion isn’t happening. Journalist points out that Blackburn’s own state has blocked Medicaid expansion from happening. In response to which Blackburn says, Damn right! No way would we ever let Medicaid expand! Actually, that’s not entirely fair. Blackburn’s response was more like: Hillarycare-Sebelius-debacle-no way would we ever let Medicaid expand! But you get the idea. It’s quite possibly the most cynical exercise in Obamacare-bashing I’ve ever seen.
Jonathan Cohn: Obamacare Signup Surge: Republicans Say Obama “Cooking the Books”: “As of… last week, more than 6 million people had selected a private insurance plan through one of Obamacare’s new state marketplaces…. before a weekend of huge traffic….
These figures would seem to undermine—or at least weaken—the argument that Obamacare is a catastrophic failure…. Some, like Senator John Barrasso of Wyoming, say the administration is “cooking the books.” Others, like Senator Ted Cruz, say that the number of people without insurance is actually rising. Sorry, but that’s nonsense. Conservatives making these arguments typically cite the same evidence that Cruz did in his interview: Surveys by McKinsey and Company suggesting that most of the people buying insurance on their own already had coverage…. But McKinsey’s survey included everybody buying individual coverage—in other words, people buying through the new marketplaces and people buying directly from insurers. And nobody would expect many of the latter to be among the previously uninsured….
A better way to measure progress is to look at numbers from a handful of states that are collecting this kind of data…. New York officials told CNBC that 59 percent of people getting insurance through the state marketplace had no coverage before. The numbers were even higher in Kentucky, where officials told the network that 75 percent of people selecting plans had been uninsured before…. Officials in Washington state… believe that the overall effect of Obamacare has been to reduce the ranks of the uninsured by about 25 percent….
Of course, in places like Georgia and Texas, where officials have tried to undermine the law and refused to expand their Medicaid programs, far fewer people will get coverage…. Everybody should be cautious about making firm prounouncements about how the Affordable Care Act is doing. But right now it’s not the Administration making the most preposterously definitive claims about the law’s success or failure. It’s Cruz, Barrasso, and all the other hard-core Obamacare opponents on the right.
Paul Krugman: Obamacare, The Unknown Ideal : “It’s not my ideal…. I’d call for single-payer, and… the government in directly providing care. But Ross Douthat… warning his fellow conservatives… tell[s] them that they’re going to have to come up with a serious alternative. But Obamacare IS the conservative alternative… what a health-care system that… [makes] sure that people with preexisting conditions can get coverage has to look like if it isn’t single-payer….
Suppose you want preexisting conditions covered. Then you have to impose community rating…. But just doing that causes a death spiral, because people wait until they’re sick to buy insurance. So you also have to have a mandate…. And to make buying insurance possible for people with lower incomes, you have to have subsidies. And what you’ve just defined are the essentials of ObamaRomneyCare…. If you think there’s some magic market-based solution that obviates the stuff conservatives don’t like while preserving the stuff they like, you’re deluding yourself…. Any notion that Republicans will go beyond trying to sabotage the law and come up with an alternative is fantasy. Again, Obamacare is the conservative alternative, and you can’t move further right without doing no reform at all.
Greg Sargent: Do Republicans have a Plan B?: “Obamacare is on track to hit seven million enrollments….
But the official House GOP position is still repeal, and there’s no indication whether Republicans will vote on any comprehensive alternative…. GOP candidates continue to campaign on repeal while vaguely promising some sort of alternative…. Paul Ryan is set to roll out his new budget today… [but] it will not contain any effort to overhaul anti-poverty programs…. Instead, it will double down on balancing the budget in 10 years…. The GOP adherence to ideological safe zones–the unremitting 47 percenterism; the belief that the greatest threat to American civilization is debt Armageddon; the refusal to raise taxes–combine to make developing an affirmative agenda to fight poverty and boost economic mobility impossible. House Republicans still show no signs of acting on immigration….. Republican leaders themselves clearly recognize the need to tackle immigration. But they are unwilling to put forth even their own proposals to do so.
The basic GOP gamble is that Obamacare is so plainly a disaster that Republicans cannot fail to win big this fall by campaigning against it, and that taking any policy risks could upset this dynamic. But they appear to have not even considered the possibility that the law could work….
Of course, it’s true that, even if Obamacare were to improve its standing, Republicans would probably still have at least a 50-50 chance of winning the Senate. The underlying situation is terrible for Dems, and Obama’s approval ratings remain in the toilet (which is probably due to the anemic recovery). So maybe they don’t need a Plan B. I guess we’ll find out soon enough.
Adrianna McIntyre: Some quick thoughts on enrollment to date: “I’ve mostly abstained from the turbulent month-to-month commentary about enrollment…
I don’t think those reports are very useful. The… enrollment target… is a fairly empty metric, since it provides little information about the characteristics of that population and risk pooling happens at the insurer/state level. But I wanted to highlight a story from Noam Levey…. Levey got his hands on as-of-yet-unpublished survey results from the Rand Corporation…. “Uninsurance among adults has fallen from 20.9% last fall to 16.6% this month.” This is a statistic that needs to be interpreted with caution…. “4.5 million people who were previously uninsured have received coverage under the Medicaid expansion.” It’s unclear how many of these people are truly “new eligibles” vs. the “woodwork” population…. “9 million people—most of whom were previously insured—have skipped the exchange, enrolling in plans directly from insurers.” This is less important from a “how much is Obamacare reducing the number of uninsured” perspective…. But it does matter quite a lot for risk pooling….
A final point: ACA enrollment was always going to be weakest in year one…. Medicaid enrollment is expected to jump 50% between 2014 and 2015.CBO expects enrollment in exchanges to double in 2015, then reach 24- 25 million by 2017.
For those of you looking for a frame of reference, CBO projected that the number of uninsured would fall by 13 million in 2014. It’s unclear whether the ACA will achieve this. But health reform has never happened overnight, and it’ll take us months to fully understand the ACA’s impact in 2014 (to say nothing of future years). Media—and the politics it covers—generally operate on the wrong time scale for nuanced policy analysis, and Obamacare is no exception.