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The Deceitful Numbers – Great and Small – of the ACA
If you’re like me, and I know I am, you waste a lot of time at the office reading Ricochet and looking at your friends’ posts on Facebook. Wait, no boss, I’m not online at work at all. I’m reading Ricochet and Facebook at home! I made a joke about America’s unhealthy love of the internet! (Is he gone? Okay …)
For several days, at least since the new Congress began the repeal process for the Affordable Care Act (ACA), my liberal and Progressive friends on Facebook have been engaged in full bore linear conniption fits over the vote. It’s hard to sort through these because they are frequently nested within full bore linear conniption fits over cabinet member hearings in Congress, and so on.
The primary arguments against the action of Congress can usually be boiled down to three major points: that repeal will leave 20 million people without healthcare, that this one person here greatly benefited from the ACA, and that a black president passed the law.
Let’s start with the first, that 20 million people will lose their coverage. I’ve heard other numbers as well, 25 million, sometimes 30 million. The number tends to inflate with time which already raises alarm bells. I’ve also seen that repeal will leave 8.5 million children without health coverage. There we have it, the “do it for the children” argument.
The problem isn’t just the inflation, it’s that there’s no breakdown of this 20 million. The basic assumption made is that these consist of 20 million people that prior to the ACA, these people wanted health coverage but were unable to get it. This reflects arguments prior to passage, that there was something around 25-50 million people without health insurance, again spoken to imply that these poor people just couldn’t get it. Except that wasn’t the case…
That number broken down made all the difference. There were wealthy individuals who didn’t need it. There was a very large of number of young people who just didn’t see it as a necessary expense and so didn’t bother (many of these could get a major-medical plan for dirt cheap at the time), there were several who were eligible for Medicaid but for their own reasons chose not to, and then there were a large number of immigrants who entered the US illegally and thus had different barriers to coverage. Once you weeded out those numbers, the actual number of people who needed health coverage but were entirely unable was down under a million. Still large, but a less impressive number. Rather than find a way to help a million, the ACA was imposed on the entire population of 309 million.
The 20 million can likely be broken down similarly. For example, among those are people who had individual plans that were cancelled as non-compliant, and then had to go to the ACA to get a compliant plan. To Pres. Obama, those counted as “now getting insurance”. Those young people who didn’t think they needed insurance still aren’t getting insurance, at least not as a whole, so we can assume a fraction now have coverage they really didn’t plan to get. Also, there’s a not insignificant number that take advantage of the pre-existing rules to get a plan when a serious problem arises, then cancels the plan as soon as they don’t need it any more. They’re counted too. Let’s not ignore a large percentage of those who were just shuffled into Medicaid (a program that’s in financial trouble by the way). The problem is that the more we break down this number, the more likely we’re going to get around a million, and it will be increasingly difficult to condemn the 310 million to a bureaucratic morass to service that million.
The other argument, here’s someone who benefited from the ACA, is on the other side of the spectrum. Unfortunately, though the stories can be poignant, the evidence there is anecdotal. There’s one showing how his father had a prescription he paid three dollars for that the receipt shows the actual price was $1003. Thanks Obamacare! Clearly if you’re against the ACA, you want this man to suffer and die (actually this is a frequent theme with anti-repeal proponents).
The problem with anecdotal cases is that they can be countered by similar cases on the other side. In fact, there was a lot of this prior to the ACA’s passage. Proponents would wheel out people who needed help in some way, while opponents would wheel out cases where bad or fatal things happened to people under government run systems. Both sides were demonstrating valid cases, but neither really made the case definitively because of them.
And unfortunately, a lot of these cases need vetting. Much like the sudden rise of incidences of racism after Trump won – many of these proving to be hoaxes – the veracity of the claims remains indeterminate. The above example, for instance, shows on Facebook as a close-up of the two numbers, but we don’t see all that picture to get an idea of what went on.
Moreover, as Ricochet Moderator Midget Faded Rattlesnake points out, what you actually pay for medical care, what you’re billed, and what all this actually costs can be separate and wildly different things nowadays. Actual costs and benefits are obscured to hide the former and tout the latter. Yes, in this instance we can see benefit, but more information is needed and we need to be able to verify the story.
The last should be a trivial argument, but because it’s been ingrained for the duration of the Obama Administration, it needs be addressed. I mainly have seen a post from Black Lives Matter advocate, Shaun King, stating that when he talks to opponents of the ACA, they can’t list any reasons why they are against it other than it was designed by Pres. Obama. Thus, racism is why they support repeal. This really isn’t an old argument. Prior to passage, the ACA’s opponents were labelled racist. Tea Party protestors were pilloried in the mainstream media and social networks as unreasonably racist. This was never proven, other than the tautological reasoning of “only a racist would be against the ACA.”
This ignored any of the origins of the various Tea Party groups which began to spring up during the Bush administration as a protest against runaway government spending. The fear was that the ACA would bring about even more runaway spending. The CBO scored it as “budget neutral”, but when it was revealed that the ACA’s neutrality was based on ten years of funding stuffed into eight years of spending, it was clear the books were cooked and in fact we’re finding it was quite the case.
The arguments against it today are a-plenty. We were bald-faced lied about being able to keep the doctors we liked and the health plans we liked. We were bald-faced lied about rate increases. The president promised rates would go down, but they did the exact opposite of that. The entire act depends on national coercion – it requires you purchase a product. And not just that, it’s as if the government passed a law “everyone must buy a car every year. You can buy any car you like as long as it’s a Cadillac.” There’s no way such a plan could be sustained without serious pocket book trouble.
And they are not even honest about alternatives. Pres. Obama has defined health coverage as “anything that covers everything the ACA requires”. Thus, if a Republican alternative doesn’t, for example, require the elderly to cover maternity costs, it’s not counted as health coverage and he declares “they have no alternatives.” Using language this way has been a major theme of the Obama administration. You can win any argument if you change definitions of words mid-discussion to fit your purposes.
Oh, by the way, do you love giant corporations getting big favors from government? Well if you do you’ll love the ACA! The last several years have seen more and more smaller insurance companies falling under the wings of the giant health care companies. In five states, there’s only one insurance carrier available for anyone – thanks for all the competition, ACA! Because the government now determines what must be covered and by how much and how they can do it, smaller companies can longer operate. They can’t offer smaller, better products with better service, because they’re bogged down in red tape.
We can easily go on. The argument that there are no complaints against the ACA is either willfully ignorant or wholly dishonest. In either case, it’s not worthy of arguing. This is a microcosm, really, of most Progressive arguments today. They will never give the other side the benefit of doubt or assume we argue in good faith. It’s far easier for them to argue ad hominem.
It can be summed up like this, really. Recently my Progressive friends have been sharing an article saying that Trump got the most votes in states with the most people with Obamacare. It’s intended as a, “What’s the matter with Kansas?” piece – why did all these voters vote to screw themselves and their fellow man? If they could argue in good faith, they might see the other side’s perspective. Perhaps Trump got so many votes because these people know very well what the ACA is doing and they don’t like it.
Published in Domestic Policy
One more distortion on that 20 million number. My coverage was cancelled as of Jan 1st (insurer fleeing the state), and I had to find new Obamacare compliant coverage. Anyone want to bet that I’m now counted as two people ‘getting coverage’?
Exactly. This is also is part of a bigger pattern with Progressives: cooking the books — for example, look at California’s “Balanced Budgets” that have given it a rather large deficit.
Part of the “non-insured” prior to the ACA included people who changed jobs. If they went without insurance for a day, they were counted as not having insurance for the year. We have no reason to believe the books are similarly fixed with the present ACA.
Well put.
A set of good tires for my car is about $1000. Why is that important? 50% of our citizens have less than a grand in savings. More than 25% of of those have no savings at all. What is that important? Deductibles run from $4000 to $9000 which basically bankrupts half the population . IMHO the ACA was of no help for these people and a hindrance to everyone else.
The left seems no more concerned about the sustainability of nationalized health care than rightwingers care about the sustainability of our use of fossil fuels. And the former is a more urgent and immediate problem. We need to hold people responsible for the sustainability of the programs they advocate.
That is an excellent point. I was once told that it is only a matter of time before my employer dumps everyone on to the exchange. Why? It is too expensive for them to keep covering everyone. It would benefit them far more to give everyone money to go to the exchange and buy their own. Every year, my coverage goes down and the expense stays around the same (or in some cases goes up!). Every year, the coverage is reduced, the out of pocket max goes up, the deductible goes up. It’s only a matter of time before it is more cost effective to take the hit and pay the penalty.
This is what the ACA has done. It is less expensive to pay a penalty than to pay for the insurance.
Thank you for posting this. It is an ongoing ad hominem argument. The argument is never about the numbers and providing better care. It is always an attack on anyone who dares suggest that the ACA is not a good plan.
Immediately following that, they will tell you that everyone needs time to discuss it. I seem to recall the ACA being passed swiftly and without too much debate. How different it is when the shoe is on the other foot!
I’ve one Liberal friend who admits it’s horrible. He, however, thinks it’s because it helps the corporations more (which it does in part), and thus we need a full government run plan.
I’d suggest that this piecemeal plan is going to make things worse if the government takes over. Other countries handed healthcare to the government swiftly — they turned a well-run industry over to their governments who ran it down. In the US, the government has already run it down. It’ll only get worse should we go full-on government run.
Continuing the big fat lie that is ACA, I got a kind letter from the IRS a couple days ago because we didn’t have insurance in 2015 and they sent me a penalty, which I didn’t pay. (We had business losses, so there was no refund from which to take the penalty. And since the penalty is unenforceable, I filed the IRS penalty statement in the round file while muttering several expletives.)
This kind letter from the IRS reminded us that we would owe another penalty for 2016, unless we had a qualifying plan. Then it proceeded to tell us that plans were available through ACA for as low as $75 per month, depending on financial something or other.
Are you [expletive] kidding me? I know people who make next to nothing who can’t find anything on Obamacare for $75/month. The [expletive] IRS is lying. After reading the letter I asked my wife if it’s possible to sue the IRS for false advertising.
No. No you cannot. But the IRS is just another shill for the ACA, so… let’s just remember.
The government writes the rules, so they don’t get penalized for false advertising.
Are you sure? Maybe not a lawsuit, but there are a lot of people who want to get the government involved in shutting down fake news these days, and this would seem to be a prime example.
Sure, but that’s more of a fantasy. Unless the ACA goes away and the IRS gets out of healthcare (YAY!).
You are right about the numbers but that’s not really the issue. The ACA brought us a really bad system. It needs to go away. There is a way to build a much better approach maximizing the roles of private sector business, including healthcare providers, insurers, and employers, and the individuals who need to have ways to provide for their and their dependents’ healthcare, while reducing or even minimizing the government role. Donald Trump is quoted as saying he wants everyone to have insurance. I take what he is saying to mean he wants all to have a pathway for covering their healthcare needs. This can happen.
I’d be really interested to know the net change in insurance coverage. That is, how many people have coverage now who had none before the ACA versus how many people suffered disruptions in their coverage (like Judge) because of the ACA. I’m willing to bet we’ll never know because the numbers are so unflattering to the law.
Also, they’re going to include expansion of MediCaid, so it’s a little bit like nailing jello to a wall.
Great post! Well done!
It’s the reverse, and minus the racism: We don’t like Obama b/c of the ACA.
Indeed, it is not the provision of health insurance, but the banning of health insurance.
Yes. Long live Kevin Williamson, who makes this point often! Government regulation our well-meaning friends tells us protects the little guy from the big corporation only makes the big corporation bigger. This is because it chains down the little corporation so the big corporation can eat it.
When the little corporation is gone, the big corporation turns on the little guy and eats him.
That’s the Democrats caring about the poor.
Indeed. Shall we also mention the regular lie that there are no Republican alternatives to Obamacare? As if Tom Price did not exist.
Tell them we need to repeal it to see what actually goes away. When people look at you funny for saying that, point them to that noted health care expert Nancy Pelosi.
I have a little anecdote of my own. In 1993, President Clinton signed a law (it was primarily HIPPA) that made it illegal for insurers to deny coverage to anyone, even those with pre-existing conditions, if they not gone uninsured for a certain length of time, 18 months, I believe.
I was advised of this fact by BC/BS when I called them because my COBRA was nearing its end. I had a pre-existing condition, chronic migraines since I was a teen. I obtained a very generous policy. My last monthly premium pre-Obamacare in 2013 was $450/month. This policy was cancelled effective 1-1-14 due to the ACA.
Flash forward 4 short years.There is only one insurer in the so-called Marketplace. I lowered my level to Silver this year because of the cost (I’m going for Tin next year). My individual premium is $1400/month. I also have 3 co-pays for name brand meds I take: 2 are $800/mo. and 1 is $600/mo. These are the maximum co-pays which I’ll be responsible for since the list price of the Rxs are over $1,000. I have ‘coupons’ for these medications but they pay only $150 or so.
So if you’re keeping score at home, I’ll be paying $3,600/month for 1 person until I meet my deductible and my out-of-pocket yearly maximum. (cont’d)
(cont’d)
If it were just me, I’d say screw it but unfortunately my husband has Early-Onset Alzheimer’s so I need to be sure I can remain healthy to take care of him, not that my ACA policy achieves this goal.
When I tell this story, very people believe it so I keep my bills and receipts. I have been a vocal opponent of Obamacare since the beginning because, as a former insurance broker, I knew the combination of government + medical care was toxic. The 1st year, 2014, I was interviewed for pieces at CNN, Yahoo, the NYT and the Philly Inquirer. Only the NYT did not include me in an article although their health reporter, Robert Pear, calls me 1 or 2 times a year to check in.
I received a subsidy of $175 for the first 2 years but thankfully I no longer receive it because I ended up re-paying the entire amount at tax time. Everyone I know that has been on it has had to pay the entire amount back at tax time but no one seems to be able to understand this.
We are eroding our lives’ savings at an alarming rate but I guess complaining makes me a racist.
I have always believed that the people that couldn’t get insurance were almost all just people who didn’t want to pay for it.
Orthodox Christians with a home church have a nice alternative. Samaritan Ministries. It works, it saves money, and it’s easy at tax time. (If anyone reads this and signs up, please PM me! I can get an extra discount for recruiting people!)
Oh, one point I forgot to mention. My plan is a PPO. I literally (and not in the Joe Biden sense) almost died from renal failure in 2015 because I was in one of the ACA’s crappy HMO plans. Eight procedures, nephrostomy bag for 4 months, ER visits, constant infections, all due to one kidney stone. After the brush with death, I was finally permitted to go to Thomas Jefferson University Hospital Urology Department who fixed me up with one procedure.
There was talk that all PPOs in the Marketplace were to be removed this year or next, if that were to happen I don’t know what I’d do.
#AndHenceMyVoteforTrump
Penny wise, pound foolish. They look at all these things and if they’d started by doing a decent job (not even good!) In good faith, you wouldn’t have had your problems. I’m sorry you have gone through this. It’s BS.
…and again we are reminded that the people who can afford it the least and who are the most sick are the ones who suffer. They’re too sick to manipulate the system to get decent care.
Our health care system had multiple problems before ACA. Third party payer, unreasonable litigation, incomprehensible insurance documentation, care management by other than patient/doctor actors among others. All these problems are made worse not better by ACA. This situation was no surprise to those of us who took the time to study the problems and the ‘solutions’ offered by the ACA. It was predicted over and over but some voters preferred to close their eyes and Hope. Insurance companies were recruited by the reality that they would no longer have to sell their product once the mandate was in place. The false promise of ‘free’ is attractive to all who want someone else to pay their bills. Tom Price has presented one of several good alternative plans to lead us away from this morass. His great difficulty will be overcoming those who still see personal benefit in keeping the current system in place.
I wish him great success. I will not personally benefit since at my age my only option is Medicare but for my progeny and my country I am pulling for Mr. Price.
I think you must be mistaken. The Senate Minority leader and the President have both said otherwise, have they not? Surely I shouldn’t trust you and reality over the Senate Minority Leader and the President! It’s not like the party that cares so much about poor people would lie to us, is it?
I got that same letter, with the added proviso that they mentioned that I’d taken the exemption from last year’s penalty because it was too expensive. Which it was. I’m taking the exemption again this year, if it still exists by April.
That “$75 insurance” is what you get if you’re not completely poor. I you’re actually middle or lower-middle-class, it’s grossly expensive. The last estimate I got was about $500 a month with a $7000 deductible. I’d have to have $13,000 in bills in one year before I broke even. So when I did my taxes last year, I checked that particular box. Even if I did have to pay the penalty, it would still be massively cheaper.
I’m pushing 60, and my total medical expenses over the last 30 years is less than one month’s payment…
Again, Obama has declared the Republicans have “no alternative” by so narrowly defining the language such that an alternative must necessarily cover and perform exactly the same as the ACA. So of course Republicans have had several alternatives, but by Obama’s definition they aren’t alternatives at all.
This Administration loves playing with words and definitions like that. It’s how we’ve have had no foreign terrorist attacks on American soil during his presidency. He defined it so narrow that no terrorist attack fits the definition.