So much misinformation abounds on the topic that sorting through it is more laborious than just reading the 2,409 page pdf version you can find here (not that the law will make much sense to you, either). I've found that AARP seems to have some easily understood information about the ACA and a nice tool there to help you get a quick understanding of what it means for you in your state. But what the current trend seems to be boiling down to at this early stage is a description of the "winners and losers" from the "having to have insurance" perspective.
I'll let the pundits and those who like to crunch numbers and use statistics to lie....errrr, to provide some insight and predictions, mostly because doing math ranks right up there with a multiple tooth pull without anesthesia for me.
But I think the focus on this piece is just a tiny component of - and a detraction from - a much bigger and more important aspect of the ACA. The fixation on winners and losers at this early stage of the "implementation game" reminds me of one of the aspects of my addiction disease -specifically, the need for instant gratification. While I recognize the importance of who will and will not receive insurance coverage, as well as the need for value when figuring out how each of us individually will pay for a plan that works for us, we're losing sight of the bigger picture; the longterm impact of the ACA on overall healthcare costs and providing coverage to those who previously were banned from it because they were too much of a risk for insurance companies to take on.
Denying those individuals coverage may have saved insurance companies money because they didn't have to cover the costs that people with pre-existing conditions incurred as a result of treatment. When those same people presented at the Emergency Room with acute symptoms, the subsequent increase in costs that the hospitals incurred as a result of having to absorb those "losses" was then passed on to us to cover those people's treatments. This didn't impact insurance companies at all, and they simply increased their own plan costs to us as well. So all of us bore the brunt of these costs and the insurance companies came out smelling like a rose on the deal.
So when I think about the ACA, as I did yesterday when discussing this issue with a Tea Party "enthusiast," he continued to focus on the short-term, addict view, while I went to the 30,000 foot view. Implementation pains are nothing new to anyone who has either witnessed an effort to launch a large scale project or has worked as a project director or a program manager to implement a new policy or program in their organization. For a project of this size and scope, we need to realize that there will be bumps, challenges, and difficulties along the way. It doesn't help that a faction of our population is doing everything within their power, including outright lying, manipulation of data, and fear-mongering to accomplish their goal of stopping the project in its tracks.
The real "proof in the pudding" on the efficacy of the ACA will not lie in how many people enrolled on day one, or whether the web page for enrollment is working properly; these are red herrings that will mean little when examining the big picture. The proof will come several years from now, when we are able to examine some of the data related to costs of healthcare overall and whether or not people in the US are being better served by the system in general. Until then, I think we're on a fool's errand if we are coming to conclusions about whether the ACA is "good or bad," based on who's currently "winning or losing."
Obamacare’s Winners and ‘losers’
If the Republican National Committee had written the script
for the week, it wouldn’t have gone quite this well for the right. The
political world took a relatively obscure element of the debate over
health care – insurers informing consumers about replacing poor,
outdated coverage plans with new, better plans – and turned it into a
“controversy.”
In an amazing twist, conservative Republicans who are
desperate to take away coverage for millions of Americans are pretending
to be outraged on behalf of Americans whose plans are being upgraded.
As we talked about earlier in the week, I’m not terribly impressed
by the sudden apoplectic outburst from reporters and Republicans, but
let’s consider the above pie chart and get a little more specific.
MIT’s Jonathan Gruber, an economist who helped then-Gov. Mitt Romney (R) shape health care reform in Massachusetts, told Ryan Lizza
this week about a percentage breakdown: how many Americans will be
unaffected (consumers who’ll keep their current employer-based plan),
how many will break even (those who’ll get a new plan, but it’ll cost
the same as their current plan), who many will win (those who’ll get new
coverage that’s cheaper than what they’re paying now), and how many
will “lose” (those whose new plan will be better, but will cost more).
It led University of Michigan economist and Brookings fellow Justin
Wolfers to put together the above image based on Gruber’s assessment.
To be sure, the point isn’t to say that those 3% in the red
slice are unimportant. Obviously, everyone matters. Rather, if all you
relied upon was general media coverage over the last several days, one
might assume that that the “losers” under the Affordable Care Act
represented nearly 100% of the U.S. population.
They’re not. It’s not even close.
Gruber told Lizza that 97% of Americans will either be left
alone or will be clear winners. “We have to as a society be able to
accept that,” he said. “Don’t get me wrong, that’s a shame, but no law
in the history of America makes everyone better off.”
I’ve seen some overnight pushback, arguing that Gruber’s
numbers are rough estimates, not precise assessments. That’s true.
What’s more, results will also vary by state. But let’s not miss the
forest for the trees – even if the totals are off by a few percentage
points, the key takeaway here is that the hair-on-fire coverage about
Americans “losing” their current health plans, and having insurance get
“canceled” on them, has been exaggerated to levels that clearly mislead
the public at large.
For that matter, in case this isn’t obvious, the “losers” in this scenario aren’t actually losing
– they’re paying more for better coverage and more health care
security, which will almost certainly save them money if, say, they get
sick.
Dylan Scott explained
this morning, “What really matters is, what happens to the people who
are receiving those cancellation letters that congressional Republicans
have been parading in front of the cameras? The bottom line: Almost all
of them are going to receive the same or much better coverage, and many
of them are going to receive financial help to purchase it.”
If this week is any guide, we’ll see just about every single
American in that 3% tell their story very soon, but to think they’re
representative of most of the country is an important mistake.
Postscript: Let’s also try to remember that phasing out old,
substandard plans is something to be celebrated, not condemned. As Jon
Chait noted
this morning, the sooner the awful insurance goes away, the better it
is for all consumers and the health care system in general.
Josh Barro, writing at Business Insider breaks the numbers down with the details as he see's them. I wouldn't quite call the numbers "garbage" as Barro does, but it's worth noting that overall, Barro's piece is actually quite supportive of the impact of Obamacare. Not sure that was his intent, but after reading it I was largely appreciative of his discussion, given that he believes that:
" It's clear that Obamacare creates more winners than losers, but this chart and the analysis behind it don't shed much light on the ratios."
Here's What's Wrong With That Obamacare 'Winners And Losers' Chart That Everyone Is Passing Around
The New Yorker's Ryan Lizza interviewed Jonathan Gruber,
one of the key architects of the Affordable Care Act, trying to figure
out what share of the population might be made worse off under the law.
They came up with some numbers which economist Justin Wolfers turned into this pie chart. Everyone is passing it around.
Unfortunately, except the 80% largely unaffected, these numbers are garbage.
According to Lizza, Gruber marks 14% of the population as clear winners because they are uninsured now but gain access to affordable coverage. That would be about 45 million people as of 2016, when the Affordable Care Act is in full swing.
But according to the Congressional Budget Office, the law will only increase insurance coverage by about 26 million people through 2016, or 8% of the population. That's the group that can be called "clear winners"; 14% is too aggressive an estimate.
Another 30 million people in the U.S. (9%) will still be uninsured in 2016. This group of non-winners includes:
While this group can keep similar coverage to what they had before, their plan premiums may change greatly — in either direction. Young and healthy people with high incomes will no longer benefit from "medical underwriting" that lets insurers sell them inexpensive plans on the grounds they're unlikely to get sick. People with low-incomes or high medical needs will likely see their net premiums fall.
Finally, about 3% will have to buy more comprehensive plans than they now get through the individual market. Lizza labels this group as "potential losers," but some of these people are actually winners: They'll get better coverage than they used to have, and it may be at a lower cost after federal subsidies. But some of these people will pay more for a costlier insurance plan they didn't want.
It's clear that Obamacare creates more winners than losers, but this chart and the analysis behind it don't shed much light on the ratios.
Unfortunately, except the 80% largely unaffected, these numbers are garbage.
According to Lizza, Gruber marks 14% of the population as clear winners because they are uninsured now but gain access to affordable coverage. That would be about 45 million people as of 2016, when the Affordable Care Act is in full swing.
But according to the Congressional Budget Office, the law will only increase insurance coverage by about 26 million people through 2016, or 8% of the population. That's the group that can be called "clear winners"; 14% is too aggressive an estimate.
Another 30 million people in the U.S. (9%) will still be uninsured in 2016. This group of non-winners includes:
- Unauthorized immigrants who aren't eligible for any part of Obamacare.
- Low-income authorized immigrants present in the United States less than five years who aren't eligible for Medicaid.
- People who decide they (for whatever reason) don't want to buy insurance coverage, who will still be uninsured and will have to pay a new penalty.
- People with incomes under 100% of the poverty line who live in states that didn't expand Medicaid.
While this group can keep similar coverage to what they had before, their plan premiums may change greatly — in either direction. Young and healthy people with high incomes will no longer benefit from "medical underwriting" that lets insurers sell them inexpensive plans on the grounds they're unlikely to get sick. People with low-incomes or high medical needs will likely see their net premiums fall.
Finally, about 3% will have to buy more comprehensive plans than they now get through the individual market. Lizza labels this group as "potential losers," but some of these people are actually winners: They'll get better coverage than they used to have, and it may be at a lower cost after federal subsidies. But some of these people will pay more for a costlier insurance plan they didn't want.
It's clear that Obamacare creates more winners than losers, but this chart and the analysis behind it don't shed much light on the ratios.
