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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
You all do realize,don’t you, that these horror stories are features, not flaws? The ACA was designed to destroy private medical insurance in the USA, the better to institute a National Health Service and to advance socialism.
There is no simpler explanation.
This is why there must be a repeal and a complete start over. There is so much bad in the ACA and we don’t know what those things are because nobody read it .
You gonna believe your lyin eyes???? Over The One???
Several good Senators and Representatives did read it. Coburn of Oklahoma for one. And they all warned us of exactly what would be the result. And they were, of course, correct. But, but, but, Free Stuff!!
Please take me seriously but not literally.
In 2007, I took a health care law and financing class from a professor who became a very high-profile supporter of ObamaCare two years later. According to him, the 40-50 million could be broken down into roughly (very roughly) equal categories of people who could afford insurance but did not buy it; illegal aliens; young people who were generally healthy; the temporarily uninsured (think three to four months, between jobs); and those who truly could not afford insurance but needed it (i.e., not young and healthy).
The obvious (to me) solution would be to radically expand the market for catastrophic insurance and then work with people on a payment plan. (If people want more comprehensive insurance, it should be available.) Those who can “afford” insurance often did without because they paid most everything out of pocket anyway and just wanted insurance against big stuff. Kids and temporarily uninsured might really like a cheap catastrophic policy.
But a poorly-defined problem (for political reasons) lead to a terrible solution. Not a surprise.
Yes, you are EXACTLY correct.
President Trump should, in his inaugural address, announce that per his executive order the IRS will no longer enforce any provisions of the law, including the penalty for non-compliance. Then he submits a bill to that effect to Congress. Hand it over the lectern to Paul Ryan right there on the Capital steps. January 21, 2017, 4 pm. “Public law xyz, known as the ACA, is hereby repealed effective March 1, 2017”.
They can fix it the next week.
I am actually beginning to giggle uncontrollably at this stuff. For the first time in history, the country has a Republican President who has committed himself to the Democratic dream – universal health care. On top of that, the Democrats are getting bailed out of the impending crash of the entire health care system, due to Obamacare. This should be the Democrats’ nirvana scenario. But they are so deranged that they can only run in circles emitting primal screams that make Hillary’s voice sound soothing by comparison. This is just too sweet.
So I offer these two solutions, and despite how they sound I mean them in all seriousness.
First – the “public option” Allow anyone in the country who wants it to sign up for Medicaid. (People who still want real health care could buy private insurance.) Then let Medicaid continue to go bankrupt, as it certainly will. The Democrats will have their way – everyone will have government health insurance, but no one on that government insurance will have actual, you know, health care.
Second possibility – do nothing. Let Obamacare stay in place, until the whole system crashes and everyone is screaming to repeal it. Don’t worry about a replacement. At that point, just the repeal will be good enough.
Why do I say this in all seriousness? Because no Trumpian plan to improve the health care system will ever gain acceptance, much less support, from the Democrats. So just give them their way until they self-immolate.
If you really want a healthcare plan that works, require Congress-critters to use it with no supliments.
Larry, In a more reasonable world I would be sympathetic to your proposed solutions. In this world, I fear, they are infeasible.
Obamacare was designed to fail, so that a single-payer system could be sold as the only remaining viable option. The only thing better for the Progressives than having this denoument occur under a Hillary administration would be to have it occur under a Republican administration. If the system collapses under Trump, even if it’s the fully intact Obamacare plan that fails, it will all be blamed on Republicans. Heck, the press is already saying so. Giving us single payer will be even easier once the Dems can pin the mess on the other party.
Since the Republicans are doomed to receive all the blame no matter what, they might as well take their best shot at reforming the system while they have the (brief) opportunity to do so.
I agree with that idea that the plan was always that the ACA would fail. Then the Democrats would swoop in and say, “We totally tried the Free Market with this and it failed so now it’s time for us to go in and fix this properly.” Now ignoring that the Democrats haven’t a clue what the free market is and how it was never tried with the ACA, they have another problem: They think that the mess will get cleaned up if they take it over.
They have so fouled it up that a single-payer or similar government plan will be a disaster as soon as it hits the ground if not before.
They’ve done the equivalent of dismantling a Ferrari engine bit by bit, and when it fails to work properly, they send in a kid with no experience in cars to dismantle and reassemble the engine, then declare it’s working better than before.
Most western governments handed the reins to the government when their health systems were essentially working well (if damaged physically by the war), so it’s taken time for the real damage to show.
We’re doing this the Max Power way.
You are absolutely correct that Obamacare was designed to fail. And the Democrats are hell-bent on stopping Trump from fixing it. We can defund Obamacare, but we cannot get a replacement through a filibuster. So my suggestion is intended to be utterly practical. Offer a good bill to fix it, and let the Democrats filibuster and block the fix. I am not convinced that we cannot then pin the blame where it belongs – on the Democrats.
The proposals I made here are purely political. I am aware of all kinds of ways to improve the system and control costs, but getting a real fix is not politically feasible. Since the Democrats will obstruct everything, the goal now is to make them pay the price for doing that.
Wasn’t the original bill passed in the Senate with only a majority vote required?
No sir. Funding was passed via reconciliation, but the original bill got 60 votes for cloture.
OK, so what makes you think the current situation is any different from then? They needed several republicans for cloture and now the republicans would need several democrats. Is the situation more acrimonious now than then? I guess what I’m thinking is that when there is an actual bill with features needed by constituents of Senators, some democrats may peel off.
I think the Dems only threatened to use reconciliation to do it in the Senate.
That said, it was passed in strange and evilly mysterious ways. The senate passed a terrible version no one expected the House to accept; I think what happened next was that Ted Kennedy died; the MA elected Scott Brown with the express intention of stopping Obamacare; then the Senate couldn’t get a new one passed.
So the House accepted the terrible one; pro-life Democrats who made a fine case that the law of the land would fund abortions or some such travesty sold out for a promise of an executive order to stop this–which would, according to their own case, have gone against the written law of the land and which could be overruled by a presidential whim at any point in the future.
And on top of everything else it was a bill having something to do with taxes (taxes, right?) that, by law, could only originate in the House; yet it originated in the Senate. (Or maybe that problem only follows from Roberts’ reinterpretation of the law in SCOTUS a bit later.)
There was some kind of game involved where the Senate took a completely unrelated bill from the House, something entirely innocuous, and gutted it, replacing the text entirely with their ‘terrible version’ health care text. That bill was then sent back to the House for ‘reconciliation’ between the Senate version and the original House version, with the Senate version being accepted in its entirety.
First act of President Trump: Executive Order on the ACA. Good deal.
They did not need “several Republicans” for cloture. At the time of the cloture vote, they had 60 Democrats, and the vote was on straight party lines. Not one Republican voted for cloture or for the bill. As Auggie points out, once Scott Brown was elected the Dems were stuck with the original bill. The only changes they could make were through the budget process, which affects funding but not the text of the law.
One piece of good news – the ACA is absolutely loaded (loaded!) with delegations of regulatory authority to implement the vague mandates of the statute. The Trump administration can use that authority to severely limit the ACA, without any Democratic support or any Congressional vote. And, of course, they can also defund it.
Thanks. I had really forgotten these details. I’m a little amazed reflecting on the Senate majority the Democrats had. They really lost support during the Obama period.
Please remember also that, because Obama needed all 60 Senators to jam the bill through, he gave huge bribes to some Democratic Senators who would otherwise have voted against this monstrosity. Remember the “Cornhusker Kickback” (bribe to Ben Nelson) and the “Louisiana Purchase” (bribe to Mary Landrieu)? You can review a list of the Obamacare bribes here.
By the way, both Nelson and Landrieu lost their Senate seats anyway. 8)
As an employer I looked good and hard at doing this – the same plans I offered my employees were available to them directly on the marketplace for less than I was paying. From a certain point of view, it would have been cheaper for me to pay them to buy their own. Of course the employees would then have X% of that extra pay taxed away as income so that would leave them in a worse position.
A position quite familiar to those of us who buy our own insurance. Those dollars are post tax for us too.
That is Obamacare in a nutshell. No matter what you do, nobody wins but someone loses.