Monday, April 7, 2014

Obamacare numbers prove failure not success.

The Obama administration did a victory lap last week pointing to the 7 million enrollees claimed as having signed up for health insurance through Obamacare and touted it as vindication and proof of Obamacare's success. But a closer look at the numbers, all the numbers related to Obamcare, including the effects of the policy as a whole on the problem it was supposed to solve, and the numbers show a major policy failure, not success.

Contrary to being something to crow about, the Obamacare numbers actually confirms the dire predictions of failure originally made about Obamacare by such right wing zealots as Howard Dean who called Obamacare junk,  and Warren Buffet who in 2010 predicted it would fail.

On the other side are the dependably out of touch with reality Republicans who charge the Obama administration with "cooking the books", a specious and unsubstantiated charge that on its face is as preposterous as  claims that the numbers prove Obamacare is a success.
The irony for Republicans is that they've been so busy lying about Obamacare, they miss the facts and the truth that points to Obamacare's failure .

The first thing to keep in mind regarding the original goal of 7 million set by the Obama administration is that it was more politics than healthcare, a goal so ridiculously low given the problem it was supposed to solve, that to have not hit it would in and of itself been  a monumental failure.  It was the equivalent of setting a limbo stick two inches above the ground and stepping over it and thinking you've accomplished something.

Remember that the U.S. has 50 million people without health insurance and of those, 32 million are in the category of the younger, healthier uninsured Obamacare needs to be sustainable.

Given that, and the importance of healthcare in  general, the number of people who enrolled after 6 months as the result of a program that was supposed to make healthcare more affordable and more widely available for everyone is pitifully small.

And enrollments do not equal people who have actually bought insurance. There are numbers already in the books based on the first 5 1/2 months that shows 15-20% of those who enroll never send in the check for the first premium. Blue Cross and Blue Shield just released up to date numbers that include the final day of enrollment showing that 15-20% of those who enrolled in their policies never paid the first month's premium.  If that percentage holds true across the board as it has in the  past,  the actual number of people who have purchased insurance through  Obamacare will be a little under 6 million not the 7.1 million the White House touted, missing an already artificially low projection.

And based on data already provided by the insurance companies, 75% of those who enrolled either already had insurance and switched to new policies so weren't part of the uninsured or belonged to the older, sicker group who didn't previously qualify for insurance.  Of the remaining enrollees, those in the vital younger, healthier group,  only 25%, or a little over 1 million of the 32 million needed in the insurance pools for Obamacare to be sustainable,  enrolled and it remains to be seen how many of those actually purchased policies.

Those numbers  show that Obamacare won't come close to solving the problem healthcare reform was supposed to solve which was to make healthcare more widely available and more affordable for everyone, especially for the tens of millions without it, and second,  to bring down the overall costs of healthcare which have been insanely out of control.

On the last issue, Obama claimed in his victory lap that the ACA was responsible for "bringing down the rate of growth of healthcare costs".  Having the highest costs in the world (with only the 29th best outcomes) that continue to get higher only at a slower rate is not success. Having an insane situation get more insane but at a slower rate is Cukoo's Nest reform. Not the reform the public option would have been. And healthcare reform that's been overwhelmingly rejected by the very people it was supposed to help most.

And the numbers that prove it, the numbers that matter most,  are those from the recent Gallup-Healthways Well Being Index on the overall impact of Obamacare, an index many consider authoritative and more accurate than government figures since it's compiled from many different reliable sources including the health insurance companies themselves, medical professionals, polls, over 28,000  interviews and government statistics.

The first and most striking number is that in the previous year,  before Obamacare was implemented, 17. 1% of U.S. adults were uninsured. That number has dropped to 15.9%. Though some actually try to spin that as somehow proof of success, even factoring in web site glitches, after 5 1/2 months, that the Affordable Care Act has brought down the total number of uninsured by only 1.2%  can only be called significant failure, not success. Even worse,  that number includes those who have signed up for expanded Medicaid and children who can now stay on their parents policies till the age of 26.

The index states in summary and without editorializing,  that the 15.9% uninsured is the lowest number of uninsured in six years, since 2008. But since Obamacare didn't exist in 2008,  it could be fairly asked,  after all the political angst and bloodletting, after all the country has been through, after one Obamacare mess after another from web site glitches to "If you like your insurance you can keep it", after all the scrambling Democrats have had to do to defend it,after all of Obama's speeches and dog and pony shows and celebrity commercials, what kind of healthcare reform is it that the number of uninsured now is almost the same as it was in the year before Obama even took office?

 In that year, 2008,the percentage of uninsured was 14.9%. It is testimony to current level of accepted mediocrity that a major healthcare reform overhaul which shows a net 1% increase  in the number of people who are uninsured since the year before Obama took office, could be called a success by anyone.  That more people had health insurance in 2008 before the Affordable Care Act shows how affordable health insurance under Obamacare really is no matter how many times Nancy Pelosi wants to say the word "affordable". That's not healthcare reform, that's snake oil. And chanting.

The index also shows that the biggest decline in the uninsured was among those making $36,000 a year or less. This is the group most eligible for subsides and the total number without insurance is 27.8%.  But  even among that group, according to the index, the decline in the number of uninsured was only 2.8%. 
Which means conversely 97.1% of the uninsured making $36,000 a year or less and most eligible for subsidies, rejected what was offered by the insurance companies under the ACA.

And no wonder. The low end silver and bronze policies aimed at the uninsured can run as high as $600 a month with $6,000 deductibles and 40% co-pays  in such diverse places as New York city, rural Georgia and Colorado. In Montana where there is only one insurance provider because most companies consider the population too small to set up business, it can run higher.  Premiums in other places fall somewhere in between but are generally too expensive and offer much too little in the way of coverage and accessibility to appeal to the younger healthier uninsured Obamacare needs to succeed.

It's something the White House has quietly admitted. In an article in the NY Times which didn't get much play, "White House Tightens Health Plans Standards After Consumers Complain", the Obama administration acknowledged, after receiving a barrage of consumer complaints, that the lower end health insurance plans are too expensive and offered anemic coverage .Which shouldn't be a surprise since Obamacare is a law written by the health insurance lobby themselves, the product of Obama's most significant cave in to corporate interests which amounted to Obama handing the keys to the healthcare reform chicken coop to the foxes who were part of the problem in the first place after they successfully pressured him to drop the public option.

The White House doesn't say how the problem can be fixed. Because the only way to fix it is to convince the insurance companies not just to charge less, but a lot less and offer a lot more . Don't hold your breath. The other fix is to replace Obamacare with what should have and would have been passed in the first place had it not been for Obama's lack of integrity, conviction and principle --  the public option.

For now there is talk of creating policies below the silver and bronze level called Copper policies ( really, no kidding - copper).  If that doesn't work, what's next? Wooden Nickel policies?  Most people think that's exactly what's being offered now.

If nothing changes Obamacare is headed for the oft quoted "Death Spiral" where the lack of young healthy uninsured substantially drives up  already high premiums (by 20-50% by some estimates) which will cause the entire program to collapse.

 Recently a host on MSNBC did a montage that mocked the "death spiral".They sounded like conservatives mocking climate change.And just as ignorant.  "Death spiral" wasn't coined by Republicans. It was coined by healthcare insurance economists who actually know what they're talking about who made the analysis long  before the Obamacare roll out that if the 32 million younger healthier uninsured didnt enter the insurance pools Obamacare would eventually collapse. And they didnt.

What Democrats and their  supporters need to start being honest about is that the only thing that kept the country from having the public option was Barrack Obama himself and his lack of conviction, principles and integrity.  The public option had already passed the House and days before the vote on healthcare reform 55 Democratic senators went public and said they'd vote for the public option in an attempt to give Obama a backbone transplant. The operation failed.

The solution for Democrats running in 2014 and the country is not how to defend Obamacare which can always show some minor anecdotal successes, but the public option which based on 2009 polls as many as 76% of Americans supported and in a June 2009 CBS/New York Times poll 72% supported and an astounding  66% said they were willing to  pay higher taxes to get. This is what Democrats threw overboard for Obamacare.And why senators Tom Harkin and Bernie Sanders said after the initial Obamacare vote that it was "better than nothing".  And they wonder why they were wiped out in the 2010 elections.

It's not a choice between Obamacare or nothing. That's Obama's defense when he rebuts Republican threats of repeal by saying " we can't go back to the way it was".  Those are false choices. Democrats need to start thinking about running on the pledge to replace Obamacare with the public option instead of defending Obamacare's failures with promises of endless fixing and repairing of what was a lemon of  a healthcare law to begin with. Running on "are you going to believe what we tell you or your own lying eyes" isn't going to work.

So if it's the numbers that matter,  Democrats need to be honest with themselves about Obamacare and run on replacing it with  the public option.  And do it before they see numbers related to Obamacare that are the same numbers Democrats saw after the 2010 elections. And for all the same reasons.


 The CBO recently issued numbers saying that Obamacare, while still expensive will be less expensive in the future.  This is based on primarily on government subsidies costing less and is being spun by Obamacare supporters as evidence of success. It isn't.

The reason  for the government paying out less than projected in subsidies should be obvious.  With the all numbers in for the year and 97% of those eligible for subsidies not buying policies and  no reason to think that will change,  it stands to reason the government will pay out less for subsidies in the future than originally projected. Because so few people are applying for them. Agan, more evidence of failure than success.


Obama called a press conference on April 17 to once again tout what he calls success based on updated enrollment figures of 8 million. While politically he has every right to rub the numbers into the faces of Republicans who from the beginning made specious and unsubstantiated claims because they were against any kind of reform, Obamacare is still a complete failure as a policy and what it was supposed to accomplish as already described.

 The 8 million now claimed as having enrolled is still pitifully small given the problem healthcare reform was supposed to solve and what the public option would have solved, and will be reduced even further to about 6.4 million since the 20% of those enrolling but not paying premiums has been consistant from the beginning. And Obama knows it.  As have the other percentages. Which still means that 75% of those who enrolled via the exchanges are people who already had health insurance and of the 50 million in the United States who had no health insurance at all, that number as a result of Obamacare will be reduced by a paltry and insignificant 1.5%.

His other claim, that of the 8 million (soon to be 6.4) 35% are under 35 is also, as one would expect, vastly misleading. What Obamacare needs to be sustainable, as pointed out above and by health insurance economists, is all 32 million younger healthier people who currently do not have health insurance buying in to the insurance pools. If the percentages remain consistant as they have all along, of those 35%, or 2.2 million (still a paltry number considered what's needed) only 25% of those, or about 600,000 will be those who were previously uninsured, leaving 31.4 million of those 32 million needed who are still without insurance.

Every other measure of Obamacare including the cost of healthcare which will keep going up, making it more widely accessible to people who didn't have it,and making it more affordable for everyone  is as an abysmal a failure of public policy compared to what should have been -- the public option --  as one can get. Under the public option option, everyone who didnt have healthcare coverage would now have it. Everyone. And those who had insurance through private insurance companies would have had the option of getting a much better deal through the public option.  If Democrats refuse to recognize this,and do nothing to address it,  there are still 48 million people without health insurance, and millions of others who will see their premiums go up significantly, who will remind them in the fall.


Anonymous said...

How many of those seven million had their policies cancelled because of Obamacare? The net new covered number is surely quite small.

Anonymous said...

I often read, "Medicare for All!" as the next step. I wonder if those people realize that Medicare pays for 80% of medical costs, not for all of it. We are either 1) totally and permanently disabled or 2) 65 or older, and are most likely to have high health care costs along with lower income. 20% can be a huge sum for a single hospital stay, and can bankrupt a person on a fixed income very quickly. Under Obamacare, people with Medicare can't supplement their Medicare to cover the 20%. States are not required to provide Medigap insurance for disabled Medicare recipients, as they are for Medicare recipients who are 65 or older, Luckily, my state allows disabled Medicare patients to buy Medigap insuance, but the cost for 20% coverage is about 2X the amount for full coverage under Obamacare. People who are on Medicare because they became totally disabled before 65 did not get a chance to save as much during their working years as people who retired at 65, and so need affordable insurance to cover the gap even more than people who were able to work until 65. The rationale is probably the usual, "There are so few of you, it didn't even come up." I contacted my U.S. congressman about why disabled people aren't guaranteed the ability to buy Medigap insurance like retirees, and was told by his young "Medicare Specialist" "It;s because they saved for it and you didn't." This is the best understanding a U.S. Congressman's Medicare Specialist has of SSDI (Social Security Disability Insurance). We all save for it with each paycheck! Our benefit amount is based on income earned during working years. Medicare Prescription Drug coverage also needs some work, as medicines that work often have $1,000 copays, meaning they're not available unless the recipient is independently wealthy. Medicare for all would not be universal health care, as it is.

Heather Villageliu said...
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