Making up good news about Obamacare

[Adam]

Making up good news about Obamacare

The Obama administration is celebrating that it has achieved its (downwardly revised) goal of signing up more than 6 million Americans for Obamacare by 11:59 p.m. March 31. Mission accomplished!

Not quite. The administration has not revealed how many of those 6 million people have paid their premiums. If you have not paid, you have not actually “enrolled.” It’s like putting merchandise in your Amazon cart but never clicking “buy.”

Besides, the number that matters is not how many Americans signed up for Obamacare but rather how many previously uninsured Americans signed up for Obamacare. By that standard, Obamacare may be headed for an epic failure.

Recall that between 5 million and 6 million Americans lost their health plans because of Obamacare last fall. If the administration now succeeds in signing up 5 million to 6 million previously insured Americans, it will have achieved . . . nothing. Breaking even is no great accomplishment.

[....]

Over any given six-month period since 2008, between 1.5 million and 2.5 million people have joined the Medicaid rolls just by the natural expansion of the program. Much of that figure, then, is likely just regular Medicaid growth that has nothing to do with Obamacare. Moreover, the health consulting firm Avalere examined the state-by-state numbers and estimates that only 1.1 million to 1.8 million of the claimed enrollees could be attributed to Obamacare. That’s a lot fewer than 7 million.

The Obama administration is so anxious for some good news about this law that if it doesn’t have any, it just makes some up.

Nothing particularly new or earth-shattering here for anyone who has been paying attention, but it's nice to see that the WaPo managed to print what is plainly obvious: Obama is simply making shit up as he goes along, like some child in a fantasy building a sofa-cushion fort or something. No sane person buys this ludicrous claim that suddenly yesterday there were a million "enrollments" when the site was down for half the day. Good grief. It's frankly insulting that they think anyone will buy that nonsense.

The piece does do a very good job of breaking down the numbers, complete with links, so it's an interesting source of information.

[Gingersnap]

I heard a figure today that only 800,000 or so formerly uninsured ACA enrollees have actually paid for anything.

Honestly, I don't know how the exchanges work this but in our company health plans, no pay = no insurance.

[phillygirl]

Recall that between 5 million and 6 million Americans lost their health plans because of Obamacare last fall. If the administration now succeeds in signing up 5 million to 6 million previously insured Americans, it will have achieved . . . nothing. Breaking even is no great accomplishment.

I think this is slightly misleading. I'm only going by my own personal experience here, but I imagine it mirrors a lot of others. Did I "lose" my health plan due to Obamacare? Yes. Am I uninsured because of it? No. My insurance company offered another option that qualified under Obamacare and I'm covered under that. Was it more expensive for me? Of the 6 people covered in the office, it was more expensive for 3 of us, less expensive for 3 of us. The net sum was a 7% overall increase in the premiums.

I don't like Obamacare. I don't like the philosophy. I didn't like losing my plan. I didn't like paying more money for a plan that has benefits I don't personally want, need, or use. Having said that, I think all around the reporting on the statistics should be more accurate.

[Gingersnap]

I think this is slightly misleading. I'm only going by my own personal experience here, but I imagine it mirrors a lot of others. Did I "lose" my health plan due to Obamacare? Yes. Am I uninsured because of it? No. My insurance company offered another option that qualified under Obamacare and I'm covered under that. Was it more expensive for me? Of the 6 people covered in the office, it was more expensive for 3 of us, less expensive for 3 of us. The net sum was a 7% overall increase in the premiums.

I don't like Obamacare. I don't like the philosophy. I didn't like losing my plan. I didn't like paying more money for a plan that has benefits I don't personally want, need, or use. Having said that, I think all around the reporting on the statistics should be more accurate.

I think the article pretty much said what you said, it was a break-even but disruptive change for most (not break-even individually but over all).

[phillygirl]

I think the article pretty much said what you said, it was a break-even but disruptive change for most (not break-even individually but over all).

I don't think so. But maybe I'm misunderstanding. I'm not on Obamacare. I didn't use the healthcare exchange. I continue to use the same insurance company I previously used, so I don't believe they're counting me in the sign up. I thought they were only counting those that were utilizing the actual government system. But maybe I'm wrong.

[Gingersnap]

I don't think so. But maybe I'm misunderstanding. I'm not on Obamacare. I didn't use the healthcare exchange. I continue to use the same insurance company I previously used, so I don't believe they're counting me in the sign up. I thought they were only counting those that were utilizing the actual government system. But maybe I'm wrong.

It's a break-even for the people who lost their old plans and used the exchanges to get new plans. It's a big loser situation for the people who had used narrower plans (now eliminated) and people who were "grandfathered in" since any change to the policy invalidates the policy. It's a win for the people who never shopped around before but now are shopping on the exchanges. A shocking number of people just get something and then never change it or compare it.

So, for those who have signed up and paid, it's a wash overall.

But this group is not the big group since that has been delayed. A large chunk of this group were simply enrolled in Medicaid as they would have been if they had applied anyway. The target group, the 20-something off-and-on worker who declines employer health insurance was missed at this point.

[Adam]

I think this is slightly misleading. I'm only going by my own personal experience here, but I imagine it mirrors a lot of others. Did I "lose" my health plan due to Obamacare? Yes. Am I uninsured because of it? No. My insurance company offered another option that qualified under Obamacare and I'm covered under that. Was it more expensive for me? Of the 6 people covered in the office, it was more expensive for 3 of us, less expensive for 3 of us. The net sum was a 7% overall increase in the premiums.

I don't like Obamacare. I don't like the philosophy. I didn't like losing my plan. I didn't like paying more money for a plan that has benefits I don't personally want, need, or use. Having said that, I think all around the reporting on the statistics should be more accurate.

AFAIK, pretty much all of those six million (I actually saw a figure somewhere of six and a quarter million as of February 28) were people like me: had their own individual policy, not "through" a workplace, and it was deemed "insufficient" and therefore cancelled. That's probably a lot of self-employed people who don't have an opportunity to get some sort of quasi-group policy through a trade association or some such: independent consultants of one sort or another, for example.

I don't know that for a complete certainty, but that's certainly the impression that I'm getting.

[phillygirl]

It's a break-even for the people who lost their old plans and used the exchanges to get new plans. It's a big loser situation for the people who had used narrower plans (now eliminated) and people who were "grandfathered in" since any change to the policy invalidates the policy. It's a win for the people who never shopped around before but now are shopping on the exchanges. A shocking number of people just get something and then never change it or compare it.

So, for those who have signed up and paid, it's a wash overall.

But this group is not the big group since that has been delayed. A large chunk of this group were simply enrolled in Medicaid as they would have been if they had applied anyway. The target group, the 20-something off-and-on worker who declines employer health insurance was missed at this point.

But that's where I don't know if the stats are accurately describing that. But we may be talking at cross purposes. I don't know if the opponents that are claiming "lost their insurance" is such an accurate description. I view it more as "have to pay for more expensive insurance".

And it may just be semantics, but in my mind it's different.

[Gingersnap]

But that's where I don't know if the stats are accurately describing that. But we may be talking at cross purposes. I don't know if the opponents that are claiming "lost their insurance" is such an accurate description. I view it more as "have to pay for more expensive insurance".

And it may just be semantics, but in my mind it's different.

The way I look at it is that a whole category of inexpensive insurance is no longer available to the private (non-group) market. Instead of getting a narrow (cheaper) policy, people have to get a more expensive policy with broader coverage. If you are a single person who isn't going to have kids (and you know that) and you don't ski or drink or whatever and you're fine with that and you're fine with paying a $3,000 deductible since in your world anything over a couple hundred is going to mean an ER visit or hospital stay anyway, then you got screwed.

Now, a lot of people in that category have coverage for things they can't or won't use, the deductible is higher, and the monthly payments are more.

That category isn't 50% of insurance shoppers but if you are in it, it's a bitch.

[Adam]

I think the article pretty much said what you said, it was a break-even but disruptive change for most (not break-even individually but over all).

We don't know for certain that they're the same people. A lot probably are, but we don't have any specific data to say that person A lost his insurance because of Obamafail regulations, and then that same person A then went to hindenburg.gov and signed up for Obamafail.

The 800,000 number you heard came from the as-yet unpublished RAND study. This tells us a lot, but it's not as definitive as saying that there's a straight line from someone who lost their insurance to going onto Obamafail. What we do "know" from the study ("know" in quotes because it's a survey, so there's always some variation on reality through statistical extrapolation):

1. Out of the six million who had "signed up" (not necessarily paid) as of a few days ago, somewhere between about a quarter and a third did not previously have health insurance somehow, either through their company or on their own or from their parents or whatever.
2. About nine million people have bought new plans outside of the marketplaces; these people are Phillygirl.
3. Supposedly, fewer than one million people who had insurance previously and subsequently had their plans cancelled now do not have health insurance.

Points 1 and 3 would strongly suggest a straight-line relationship from losing coverage to signing up on the exchanges, but it's not really proof.

The 858,000 truly newly-insured people number was extrapolated by the Daily Mail. I haven't gone through the actual numbers myself, but I gather it's calculated by subtracting out the not-really-known number of how many people have actually paid for their insurance (somewhere around 20%), then subtracting out the "known" number of people who were previously insured (~70%) to come up with a number just south of a million.

[phillygirl]

The way I look at it is that a whole category of inexpensive insurance is no longer available to the private (non-group) market. Instead of getting a narrow (cheaper) policy, people have to get a more expensive policy with broader coverage. If you are a single person who isn't going to have kids (and you know that) and you don't ski or drink or whatever and you're fine with that and you're fine with paying a $3,000 deductible since in your world anything over a couple hundred is going to mean an ER visit or hospital stay anyway, then you got screwed.

Now, a lot of people in that category have coverage for things they can't or won't use, the deductible is higher, and the monthly payments are more.

That category isn't 50% of insurance shoppers but if you are in it, it's a bitch.

The thing that kills me is my coverage was absolutely fine. We had birth control coverage. I honestly don't know what changed with the exception of a few well visits are covered and now certain meds (like birth control) are free rather than being charged at the co-pay rate of other meds (I think). Whatever the differences are, they aren't worth, in my mind, the increased cost. If my employees had the choice, they'd go with our prior coverage, since they now have to contribute to the cost of it.

Next year we're going to have to figure out a different co-share of the cost. We didn't have a whole lot of time to deal with it and I believe too much of the increase is being placed on the shoulders of those that can least afford it. I will do some "redistribution of wealth" planning within the firm and have those that make the most shoulder more of the burden.

[Adam]

The thing that kills me is my coverage was absolutely fine. We had birth control coverage. I honestly don't know what changed with the exception of a few well visits are covered and now certain meds (like birth control) are free rather than being charged at the co-pay rate of other meds (I think). Whatever the differences are, they aren't worth, in my mind, the increased cost. If my employees had the choice, they'd go with our prior coverage, since they now have to contribute to the cost of it.

What changed is that you are now, legally, both man and woman. Your policy, the one that covers you personally, must include both your pap smears and mammograms as well as your annual prostate exams and coverage for the testicular cancer that you, the androgynous legal entity that you are, are at risk of one day contracting. It's the result of the forced Cosmic Sameness of Obamafail: you are literally in the same risk pool as your male counterparts for things that you're never going to get, like testicular cancer, and your male counterpart is now in the same risk pool as you for developing uterine cancer. One would think that the two would "balance out," but risk pools don't work that way: adding males to the uterine cancer risk pool doesn't actually "lower" the risk, and adding females to the testicular cancer risk pool doesn't "lower" the risk there, either. From an actuarial standpoint, the same number of people will get uterine cancer and testicular cancer as before, so the risk is the same.

Next year we're going to have to figure out a different co-share of the cost. We didn't have a whole lot of time to deal with it and I believe too much of the increase is being placed on the shoulders of those that can least afford it. I will do some "redistribution of wealth" planning within the firm and have those that make the most shoulder more of the burden.

The system is specifically designed to shift the cost burden upon the younger folks, based upon the (not entirely faulty, but poorly-structured in this case) idea that young people are healthy and therefore use less health care resources. This, in theory, provides more (virtually unlimited) resources for older people, who (at least according to theory) consume more health care resources. Hence why there is so much emphasis on the so-called "young invincibles:" people below age 30, particularly white males, who at least nominally virtually never go to the doctor or the hospital.

In aggregate, all of the above assumptions are true. In practice, not so much. One of the great big problems here is that those same "young invincibles" are staying away in droves: they can pay a $95 penalty once per year instead of, say, $75/month for subsidized (or not) insurance. Even if some of those "young invincibles" are up-and-comers, their penalty is a maximum of 1% of AGI per year. Not a whole lot of 27-year-olds are making $80,000 per year AGI, such that the penalty would be $800, which might start to be a little painful. So the typical guy, just out of college a few years and grinding it out on the ground floor at $45K/year can look at his situation and say "my AGI will come out to $38,000 this year, and that $380 is still a lot less than $75/month." And for the workaday guy, getting by on $30K/year, he just wants his money for rent, food, his car, and beer. These "young invincibles" start to care when they're married and/or have children to care for, but before then, they don't, and they'll just pay the pittance of a fine/tax/levy/vig/whatever they're calling it this week rather than fool with the insurance end of it.

[phillygirl]

What changed is that you are now, legally, both man and woman. Your policy, the one that covers you personally, must include both your pap smears and mammograms as well as your annual prostate exams and coverage for the testicular cancer that you, the androgynous legal entity that you are, are at risk of one day contracting. It's the result of the forced Cosmic Sameness of Obamafail: you are literally in the same risk pool as your male counterparts for things that you're never going to get, like testicular cancer, and your male counterpart is now in the same risk pool as you for developing uterine cancer. One would think that the two would "balance out," but risk pools don't work that way: adding males to the uterine cancer risk pool doesn't actually "lower" the risk, and adding females to the testicular cancer risk pool doesn't "lower" the risk there, either. From an actuarial standpoint, the same number of people will get uterine cancer and testicular cancer as before, so the risk is the same.

The system is specifically designed to shift the cost burden upon the younger folks, based upon the (not entirely faulty, but poorly-structured in this case) idea that young people are healthy and therefore use less health care resources. This, in theory, provides more (virtually unlimited) resources for older people, who (at least according to theory) consume more health care resources. Hence why there is so much emphasis on the so-called "young invincibles:" people below age 30, particularly white males, who at least nominally virtually never go to the doctor or the hospital.

In aggregate, all of the above assumptions are true. In practice, not so much. One of the great big problems here is that those same "young invincibles" are staying away in droves: they can pay a $95 penalty once per year instead of, say, $75/month for subsidized (or not) insurance. Even if some of those "young invincibles" are up-and-comers, their penalty is a maximum of 1% of AGI per year. Not a whole lot of 27-year-olds are making $80,000 per year AGI, such that the penalty would be $800, which might start to be a little painful. So the typical guy, just out of college a few years and grinding it out on the ground floor at $45K/year can look at his situation and say "my AGI will come out to $38,000 this year, and that $380 is still a lot less than $75/month." And for the workaday guy, getting by on $30K/year, he just wants his money for rent, food, his car, and beer. These "young invincibles" start to care when they're married and/or have children to care for, but before then, they don't, and they'll just pay the pittance of a fine/tax/levy/vig/whatever they're calling it this week rather than fool with the insurance end of it.

In my group, the younger people are paying less than they were, the older people are paying more than they were.

[Adam]

In my group, the younger people are paying less than they were, the older people are paying more than they were.

Hmph. Interesting. That's different from most folks I've heard from. I guess you're (pl.) "offsetting" the folks on the exchange.

[Gingersnap]

In my group, the younger people are paying less than they were, the older people are paying more than they were.

In ours, it's the other way around kind of. Younger people will pay more than last year but older people are about the same. For those in the ordinary plans. We've scrapped the narrow plans. Those people, childless types with a tolerance for risk are out of luck. The closest thing to their old plan was a very significant jump in monthly costs. So significant that offering that type of plan is simply not cost effective for any employee.

They effectively lost their plan.