Saturday, July 25, 2015

(Somewhat) Legitimate Criticism of Obamacare, Part Two

I've had a great deal to say about conservative myths regarding the highly successful Affordable Care Act, otherwise known as Obamacare. In my last post, I commented on the fact that although it's true that some of the newly insured are using emergency rooms at public expense, those folks are also healthier, more likely to have access to preventitive care, and less likely to stick emergency rooms with expenses for which hospitals will find it difficult to get reimbursed.

This time I'll tie off the last of the partially-true criticisms of Obamare.

Criticism Two: Obamacare is driving insurance companies out of business.

True, Assurant Health of Wisconsin is closing its doors. And it's pretty clear that Assurant struggled with complying with Obamacare's new rules, such as forbidding higher premiums based on medical history and age. However, just because Assurant couldn't make it under the new rules doesn't mean that the industry in general is hurting. On the contrary. From Daniel Jennings of Seeking Alpha:

"UnitedHealth, Cigna, Aetna, and WellPoint have shown significant TTM revenue growth in the last year." "TTM revenue figures indicate that the changes to the health insurance market in the past year are having a positive impact on those companies."

Last September, Daniel Mangan of CNBC also pointed out:

"The number of insurers set to sell health plans on Obamacare exchanges in the upcoming open-enrollment period is 25 percent higher than for 2014, as 77 issuers jump into that market."

Finally, some states saw few insurers ready to operate on the exchanges in Obamacare's early days. Now choice of plans is growing. From blogger demoinesdem at

"The Iowa Insurance Division announced today that "seven companies have applied to offer Iowans health insurance through the federal health insurance marketplace" for 2016. This year, Coventry was the sole provider selling through the exchange, following the collapse of CoOportunity Health. Although Iowa's dominant insurance provider, Wellmark Blue Cross/Blue Shield, is staying off the exchange for another year, Coventry and Minnesota-based Medica want to sell individual plans statewide, and United Healthcare wants to sell in 76 of Iowa's 99 counties."

Criticism Three: "Giving people Medicaid insurance is almost like giving them nothing, because you can't find a doctor that will see Medicaid patients." - Republican house majority leader John Boehner

As I discussed in my last post, there's some truth to the claim that folks newly insured with Medicaid are having trouble seeing clinicians, and busy clinics are instead referring them to emergency rooms for care. This problem however is fairly limited. From Jason Millman of the Washington Post:

"The Commonwealth Fund, a health research foundation supportive of the health-care law, is out with a new survey this morning examining the experiences of the newly insured under the Affordable Care Act. The survey, conducted by SSRS between April and June, found that 60 percent of people with new coverage, either through Medicaid or a private health plan, said they had already visited a health-care provider or filled a prescription.

Just about one in five of those with new coverage, though, said they tried to find a primary care doctor — but of those, 75 percent said their search was somewhat easy or very easy. And once they found a primary care doctor, most new enrollees said they were able to make an appointment within two weeks."

 According to a study just released by the peer-reviewed journal Health Affairs, primary care has actually improved for Michigan Medicaid patients under Obamacare. The authors conclude:

"It is noteworthy that Medicaid appointment availability in Michigan increased rather than decreased during a period when approximately 350,000 adults entered the Medicaid system and the number of primary care providers likely remained stable." and that, "appointment availability increased 6 percentage points for new Medicaid patients."

Conservative cyberspace has also been circulating the claim that, "214,000 doctors refuse to take patients with insurance bought on marketplaces." Long story short, rates this claim as, "False."

Criticism Four: The President said, "If you like your plan you can keep it." That wasn't altogether true.

Yes, but it was about 99.8% true. At one time, we heard claims that millions had seen their policies cancelled. Here's an update on the facts, as summarized by of Forbes:

"About 2.2% of Americans who purchased coverage on their own, or 400,000 people, had individual policies cancelled, according a new analysis from the nonpartisan Urban Institute. And just 0.3% of  Americans with coverage through their employer, or 500,000 people, had their health insurance policies cancelled in 2014, the Institute said. Authors of the issue brief, funded by the Robert Wood Johnson Foundation, said there was no evidence of a significant number of policy cancellations in either the self-insured or small group markets."

And even among this group, we have to ask how many really lost policies they liked and planned to keep. As I've pointed out before, while it's true that certain health care plans are no longer available due to changes in the law, many of these were not insurance at all, but junk plans that didn't offer real coverage.  Furthermore, Obamacare is not the reason why most of the folks who changed plans did so. On the individual health insurance market, plans typically are sold with one-year contracts that change prices and/or benefits year-to-year. Even before Obamacare, only 17 percent of consumers in this market kept the same plan for two years or more. Fewer than one million people who previously had individual market insurance transitioned to being uninsured. And insurers were given the option of continuing even the junkiest plans for one year after Obamacare went into effect.

So, did anybody lose a real insurance plan they liked? A few did. Some folks were getting cheap insurance because their plans didn't accept anyone with preexisting conditions. Those plans are no longer allowed. Sorry folks.

Criticism Five: The President said his plan would, "cut the cost of a typical family's premium by up to $2,500 a year." That wasn't true.

This last one is hard to spin. What the President said is not true. His statement was prompted by a report that estimated the total savings of everything Obamacare would do, then divideded that figure by the number of households in the country. The problem is the President used the word "premium." While Obamacare has reduced the annual year over year increase of health care costs, it certainly has not reduced insurance premiums by a couple of hundred bucks a month.

Good night, and good luck.

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