**UPDATE** New Obamacare Reality Setting in: 8M in exchanges, 35% are < 35 yrs old

[First]

4-17-14 UPDATE: 8 million enrolled under ACA

http://www.politico.com/story/2014/04/obamacare-enrollment-8-million-105790.html?hp=t1_3

President Barack Obama called Thursday on Republicans to end their quest to repeal Obamacare — and Democrats to “forcefully defend and be proud” of the law.

In remarks from the White House briefing room, Obama delivered a vigorous defense of the program, which has far exceeded enrollment expectations but remains a liability for Democrats in the midterm elections.

“I don’t think we should apologize for it,” Obama said. “I don’t think we should be defensive about it. I think there is a strong, good, right story to tell. What the other side is doing and what the other side is offering would strip away protections from those families, and from hundreds of millions of people who had health insurance before the law passed.

“I’m still puzzled why they’ve made this their sole agenda item when it comes to our politics,” he added. “It is curious.”

Obama announced that at least 8 million people have signed up for health insurance through state and federal exchanges under the Affordable Care Act.

“I think we can agree that it is well past time to move on, as a country…The point is, this debate is and should be over. The Affordable Care Act is working. The American people don’t want us re-fighting the battles of the past five years. ” he said in the White House briefing room.

“I find it strange that the Republican position on this law is still stuck in the same place that it has always been,” he continued. “They still can’t bring themselves to admit that the Affordable Care Act is working. They said nobody would sign up. They were wrong about that … They were wrong to keep trying to repeal a law that is working when they have no alternative answer.”

Details released by the Obama administration indicate that about 28 percent of people signing up through HealthCare.gov – which serves 36 states – were between ages 18 and 34 years old – the “young invincible” age group the White House encouraged to sign up to help offset the cost of covering older, sicker enrollees.

Another 5 million people enrolled in private coverage outside the Obamacare exchanges, and about 3 million more people had enrolled in Medicaid through February, according to administration estimates. Obama sharply criticized states that haven’t expanded Medicaid, leaving more than 5 million people without access to coverage.

The president also credited his signature health law with restraining health care costs.
“Those savings add up to more money that families can spend at businesses, [and] more money that businesses can spend

Not everyone who signs up in the exchange has paid their premium so the enrollment figures will probably drop somewhat. And not everyone who is covered was uninsured before. Still, the numbers beat expectations, giving the administration a chance to reframe the health law as more successful than it began last October.

The Congressional Budget Office this week released an updated projection that the law would cover 12 million newly-insured people this year. And that estimate is bolstered by the results of a large Gallup survey released Wednesday. It estimates 4 percent of Americans are newly insured in 2014 – about half of them through the exchanges

http://www.latimes.com/business/hiltzik/la-fi-mh-rand-20140408,0,6208659.column#axzz2yMCeLb47

The long-awaited Rand Corp. study of Obamacare's effect on health insurance coverage was released Tuesday and confirmed the numbers that had been telegraphed for more than a week: At least 9.3 million more Americans have health insurance now than in September 2013, virtually all of them as a result of the law.

That's a net figure, accommodating all those who lost their individual health insurance because of cancellations. The Rand study confirms other surveys that placed the number of people who lost their old insurance and did not or could not replace it -- the focus of an enormous volume of anti-Obamacare rhetoric -- at less than 1 million. The Rand experts call this a "very small" number, less than 1% of the U.S. population age 18 to 64.

The Rand study was eagerly anticipated in part because of the dearth of hard information from other sources, including the federal and state governments, which are still compiling their statistics and may not have a full slate for months.

Rand acknowledges that its figures have limitations -- they're based on a survey sampling, meaning that the breakdowns are subject to various margins of error, and they don't include much of the surge in enrollments in late March and early April. Those 3.2-million sign-ups not counted by Rand could "dramatically affect" the figures on total insureds, the organization said.

A few other important takeaways:

--The number of people getting insurance through their employers increased by 8.2 million. Rand said the increase is likely to have been driven by a decline in unemployment, which made more people eligible for employer plans, and by the incentives in the Affordable Care Act encouraging more employer coverage. The figure certainly undermines the contention by the healthcare law's critics that the legislation gave employers an incentive to drop coverage.

--Of the 3.9 million people counted by Rand as obtaining insurance on the individual exchange market, 36% were previously uninsured. That ratio is expected to rise when the late signups are factored in. Medicaid enrollment increased by 5.9 million, the majority of whom did not have insurance before signing up.

--These figures are only the leading edge of a long-term trend. "It's still early in the life of the ACA," Rand said. Its experts expect more enrollments "as people become more familiar with the law, the individual mandates increase to their highest levels, the employer mandate kicks in, and other changes occur." But their bottom line is that the law already has led to "a substantial increase in insurance coverage."

Quick recap of anti-ACA predictions made toward the end of 2013, all of which continue to fail the test of time:

1. "The ACA starting January 1, 2014 will be a calamitous, disorganized mess like the web site". Facts are the beginning of the year came and went, and there were no coverage calamities where people called their insurance company only to be told they didn't have insurance or wouldn't be covered. There were no long lines at the pharmacy for prescription drugs or ER and generally little to no reports of unusual insurance coverage issues that aren't standard fare for said industry (sactoking and the rest can certainly expound on this much more thoroughly). Certainly, no major stories that shows anything remotely widespread.

2. "If you like your insurance you can keep it." An undeniable fact that, of course, is proving to be utterly irrelevant with Rand Corp (and other studies) showing those with cancelled policies comprised less than 1M total persons, and that the net effect is still 9.3M were added since Sept. 2013 anyway (including many cancelled plans), making the point utterly moot. Will have much weaker legs by election day clearly, especially since it barely affects the overwhelming majority of voters personally to begin with. Note that conservatives routinely, some even to this day, throw around 6M as the total number of cancelled policies. We know it's not the case.

3. "If you like your doctor you can keep your doctor." No substantial reports this is a widespread problem as of today, April 8th 2014. Narrower networks of doctors, a consequence of cost controls in ACA, doesn't appear to actually mean people are losing their doctors since most (not all, but very much most) have the choice of which plans to choose that include their doctor or not. That ability to choose makes not keeping your doctor far less a talking point, though this one never had much electoral legs to begin with.

4. "Businesses will dump their employees on the exchanges". Not only are many more than 9.3M additional Americans going to be insured when this month is concluded, but employer coverage continues to be strong as unemployment has continued to come down. Has zero electoral legs now that there has been a delay of the employer mandate, with some conservatives previously claiming 100M+ employer plans would be in jeopardy because of the mandate.

5. "Web site is structurally flawed and not fixable". Uh, yeah, sure.

Who knows, perhaps Republicans can use the ACA as enough of a net positive to gain some Senate seats this year, maybe even win back the Senate for 2 years. But not only is this law staying, it's already vastly improved and working better than opposition predicted 3 short months ago. The question they have to ask themselves is, after 4 years of campaigning against Obamacare with zero to show for it (literally, nothing) while also failing to govern in the House at all, when will Repubs start governing again? Immigration? Healthcare? We gonna see anything other than gun votes or show ACA repeal votes?

EDIT; Title slightly altered.

 

[sunzt]

buh.. buh... buh.... obamacare is evil... buh... buh... communist....socialist... buh buh.. muslim... buh buh.....

IT"S A LIE!! RAND IS FUNDED BY Government!! ARRGGG yeah thats it.... EERRRAARRRAAH!!

 

[senseamp]

Rand acknowledges that its figures have limitations -- they're based on a survey sampling, meaning that the breakdowns are subject to various margins of error

See, that's the problem with this study. It's based on a survey sampling. If it was based on simply claiming Obamacare is a dismal failure, it would not need to breakdown any numbers and thus would not be subject to any margins of error.

 

[rockyct]

I think the bottom line is that Obamacare was a solution (more or less) to an issue the Republicans didn't believe was actually a problem. If a person didn't have insurance, it was their fault, for whatever reason. I understand them being opposed to the law but I hope now they can finally accept that it isn't going anywhere and it isn't going to self destruct. It needs tweaking, but enough people signed up (including young people) that fundamentally the law does work.

The law can't be repealed at this point and the Republicans know that. Kicking that many people off insurance or Medicaid, plus going back to the lower age to be on your parent's plan and allowing discrimination based on pre-existing conditions would be political suicide in national and state races.

 

[Gonad the Barbarian]

They knew it was a problem, just a bad one for them to fix:
http://talkingpointsmemo.com/edblog/the-1993-kristol-memo-on-defeating-health-care-reform
Government working to solve problems undermines their party brand.

 

[sactoking]

Not having seen the study and the methodology I cannot say this with certainty but on a preliminary basis I am skeptical of the results and their presentation/interpretation. Significant questions remain, such as:
1. The number would obviously include Medicaid enrollment. What effort was made to control for the enrollment of the previously eligible in that number? If no effort was made what is the justification for the assumption that all enrollments of the previously eligible result from the ACA and not some other factor?
2. What methodology was used to define "uninsured" and how did they ensure respondents adhered to that definition? In general, States and the federal government don't collect the days on who was previously uninsured. It's somewhat accepted that self-reporting is the only viable option but it is also not generally accurate as it relies upon the reporter's definition and interpretation of the circumstances, which may not be consistent.
3. While the net loss of insureds may be less than a million that does not make it appropriate to downplay the effects of coverage changes on those whose policies were canceled and replaced.
4. This study, like the one recently touting that the ACA had dropped the uninsured level to the lowest since 2008, seems to be ignoring the effect of economic recovery on the rate of the insured.
5. A technical quibble, but the increased Medicaid rolls do not contribute to the rate of insured or rate of uninsured. Medicaid is not insurance. A somewhat appropriate comparison would be to say that Medicaid:insurance::UI:employment

 

[fskimospy]

Not having seen the study and the methodology I cannot say this with certainty but on a preliminary basis I am skeptical of the results and their presentation/interpretation. Significant questions remain, such as:
1. The number would obviously include Medicaid enrollment. What effort was made to control for the enrollment of the previously eligible in that number? If no effort was made what is the justification for the assumption that all enrollments of the previously eligible result from the ACA and not some other factor?
2. What methodology was used to define "uninsured" and how did they ensure respondents adhered to that definition? In general, States and the federal government don't collect the days on who was previously uninsured. It's somewhat accepted that self-reporting is the only viable option but it is also not generally accurate as it relies upon the reporter's definition and interpretation of the circumstances, which may not be consistent.
3. While the net loss of insureds may be less than a million that does not make it appropriate to downplay the effects of coverage changes on those whose policies were canceled and replaced.

These three points are very good ones and I agree.

4. This study, like the one recently touting that the ACA had dropped the uninsured level to the lowest since 2008, seems to be ignoring the effect of economic recovery on the rate of the insured.

While you're right that new jobs added certainly helped lower the number of uninsured, if you look at the number of jobs created as compared to population growth over this time period I think it's pretty safe to say that job creation was not the primary driver of this decrease.

5. A technical quibble, but the increased Medicaid rolls do not contribute to the rate of insured or rate of uninsured. Medicaid is not insurance. A somewhat appropriate comparison would be to say that Medicaid:insurance::UI:employment

This is the only one that I completely disagree with. Employment is having a job, explicitly. Having money does not equal having a job. Health insurance is (broadly) having a separate entity that shields you from much/all of the risk of incurring health expenses. Medicaid is most certainly health insurance.

 

[Newell Steamer]

Could you site a reliable source please??

Because I heard from a friend, that knew someone that lived next to a family that was once in a restaurant where they were served by someone that knew someone that heard about someone who overheard a conversation from two other people on a bus that ACA wasn't all that great.

See,... you have nothing OP.

 

[glenn1]

This is the only one that I completely disagree with. Employment is having a job, explicitly. Having money does not equal having a job. Health insurance is (broadly) having a separate entity that shields you from much/all of the risk of incurring health expenses. Medicaid is most certainly health insurance.

No, health insurance is designed to only cover larger, unforeseen medical events. What you want and Obamacare has further exacerbated is turning our medical market into a "prepaid healthcare" model where small, routine, and preditable costs are covered (birth control for contraceptive reasons being an example) which is the exact opposite of the risk sharing you cite as being a benefit. Another huge negative to the ACA approach is that cost containment is an afterthought and handled by price controls if considered at all.

That policy folly has left millions without true health insurance and exposed to the vagaries of bankruptcy or worse, meanwhile causing over-consumption of medical services by those who are covered by employer-provided or Medicare policies because of the mindset "I paid for it, so dammit I'm going to use it."

 

[Genx87]

No, health insurance is designed to only cover larger, unforeseen medical events. What you want and Obamacare has further exacerbated is turning our medical market into a "prepaid healthcare" model where small, routine, and preditable costs are covered (birth control for contraceptive reasons being an example) which is the exact opposite of the risk sharing you cite as being a benefit. Another huge negative to the ACA approach is that cost containment is an afterthought and handled by price controls if considered at all.

That policy folly has left millions without true health insurance and exposed to the vagaries of bankruptcy or worse, meanwhile causing over-consumption of medical services by those who are covered by employer-provided or Medicare policies because of the mindset "I paid for it, so dammit I'm going to use it."

Ironically ACA pushes insurance more towards the catastrophic side of things except for the low low income. Which should end up on Medicaid. I am slowly warming up to the ACA. I still absolutely reject the notion the federal govt can force a citizen to buy a private product. But the basis behind it isn't that far off what I would enact in a public option. My hope is they offer even larger catastrophic plans for cheaper rates in the future.

 

[fskimospy]

No, health insurance is designed to only cover larger, unforeseen medical events. What you want and Obamacare has further exacerbated is turning our medical market into a "prepaid healthcare" model where small, routine, and preditable costs are covered (birth control for contraceptive reasons being an example) which is the exact opposite of the risk sharing you cite as being a benefit. Another huge negative to the ACA approach is that cost containment is an afterthought and handled by price controls if considered at all.

That policy folly has left millions without true health insurance and exposed to the vagaries of bankruptcy or worse, meanwhile causing over-consumption of medical services by those who are covered by employer-provided or Medicare policies because of the mindset "I paid for it, so dammit I'm going to use it."

1.) That's what YOU want health insurance to be, but the definition of health insurance is not bounded by the level of benefits you deem appropriate.

2.) Your description of cost containment in the ACA has no bearing on reality. Conservative fantasyland.

3.) I like health savings accounts and wish that the ACA had treated them better. Single payer would of course be better, but I think consumer directed health care spending is a good vehicle for cost controls for younger people in particular.

 

[Jhhnn]

While you're right that new jobs added certainly helped lower the number of uninsured, if you look at the number of jobs created as compared to population growth over this time period I think it's pretty safe to say that job creation was not the primary driver of this decrease.

Worship the Jerb Creators, you fool. All goodness flows from their benevolence.

Well, not really, but I'm sure you get the drift.

The worst thing about the ACA is signing up, thanks to attempts to address all the "concerns" of people trying to torpedo it. I figure that by the time the election arrives our Repub friends will be wearing their own raving around their necks like an albatross. Way too many people will benefit from it by then.

What they really need is more Birther/ Benghazi/ Obama the weak kneed tyrant rhetoric, with a bit of gun grabber/ Sharia Law/ Voter fraud frenzy to shore up the persecution complex. And the perpetual cause, States Rights, except when it comes to cannabis law.

And never forget that spending cuts create jobs. Always.

 

[AViking]

I haven't followed this very closely but weren't there 40 million uninsured? Why haven't they all signed up?

 

[fskimospy]

I haven't followed this very closely but weren't there 40 million uninsured? Why haven't they all signed up?

A bunch of reasons:

1.) A large proportion of the states chose not to expand Medicaid as the law designed, which means that millions of people who were intended to be covered by the law are left in limbo where their incomes are too high to get Medicaid but too low to get subsidized insurance.

2.) There are people who make too much money to qualify for subsidies but don't have enough disposable income to afford insurance for various reasons. (and people who have trouble making the payments even with subsidies)

3.) There are people who don't think they need insurance.

 

[Jhhnn]

A bunch of reasons:

1.) A large proportion of the states chose not to expand Medicaid as the law designed, which means that millions of people who were intended to be covered by the law are left in limbo where their incomes are too high to get Medicaid but too low to get subsidized insurance.

One of those torpedoes mentioned earlier.

2.) There are people who make too much money to qualify for subsidies but don't have enough disposable income to afford insurance for various reasons. (and people who have trouble making the payments even with subsidies)

A family of 4 needs an income in excess of $95K to receive no subsidy.

3.) There are people who don't think they need insurance.

Yeh, but they'll want insurance when they think they need it. In the meanwhile, they'll rely on the catastrophic coverage provided by emergency rooms, for free.

The word you're looking for is "freeloaders". It's part of the cult of "personal responsibility" & "Freedom!" so adored on the Right.

Most of the howling & raving comes from people receiving much larger employer based subsidies through group insurance. They're howling at the moon because somebody blew a dog whistle.

 

[Fayd]

"cut the average family&#8217;s premium by about $2,500 per year."

still failing after all these years~~

 

[sactoking]

This is the only one that I completely disagree with. Employment is having a job, explicitly. Having money does not equal having a job. Health insurance is (broadly) having a separate entity that shields you from much/all of the risk of incurring health expenses. Medicaid is most certainly health insurance.

In my world, regulating insurance, Medicaid does not meet the legal definition of insurance. It is a program that resembles insurance, especially to the recipients (you get sick and your bills get paid) but it is not technically insurance. That's why I made the admittedly imperfect comparison to unemployment: getting money for your time (you're supposed to be searching for a job while receiving UI) is kinda like being employed but it's not actually the same as being employed. This is very similar to the quibble I have with the constant ACA confusion between health insurance and health care.

 

[rudder]

Yet another obamacare thread. The website is a mess, still un-secure and the government cannot say how many people have actually paid premiums.

Premiums are rising across the country. http://www.unionleader.com/article/20140408/NEWS1201/140409269

Insurers cut the number of doctors in their plans...

http://articles.latimes.com/2014/feb/04/business/la-fi-obamacare-patients-20140205

and a lot of major hospitals are not accepting obamacare plans...

http://health.usnews.com/health-new...2013/10/30/top-hospitals-opt-out-of-obamacare

insurers are limiting the number of networked doctors...

http://sanfrancisco.cbslocal.com/20...complain-about-limited-doctor-choices-nearby/

And many doctors simply plan to opt-out...

http://www.nbcconnecticut.com/news/...ccess-health-insurance-doctors-244415971.html

Links are just a sampling. Point is obamacare is sucking (but we must embrace the suck) and the o-zombies will go to their grave spouting the wonder of obamacare.

 

[fskimospy]

In my world, regulating insurance, Medicaid does not meet the legal definition of insurance. It is a program that resembles insurance, especially to the recipients (you get sick and your bills get paid) but it is not technically insurance. That's why I made the admittedly imperfect comparison to unemployment: getting money for your time (you're supposed to be searching for a job while receiving UI) is kinda like being employed but it's not actually the same as being employed. This is very similar to the quibble I have with the constant ACA confusion between health insurance and health care.

My guess would be that Medicaid does not meet the legal definition of insurance because there is no contract, no premiums, and no explicit distribution of risk? (although I would argue that the government is in effect one huge insurance company)

I would say that for the purposes of public policy and the purposes of what the ACA was intended to achieve, the aspect of insurance that is most important to people is the protection against financial risks due to medical care. For those purposes Medicaid is insurance.

 

[michal1980]

ignores all the illegal big/small business delays put in by Obama for political cover. Makes claim that insurance through work place hasn't been effected. hmm. I wonder way?

 

[fskimospy]

ignores all the illegal big/small business delays put in by Obama for political cover. Makes claim that insurance through work place hasn't been effected. hmm. I wonder way?

Can you describe what delays you are talking about and how you think they would affect insurance through the workplace?

 

[First]

In my world, regulating insurance, Medicaid does not meet the legal definition of insurance. It is a program that resembles insurance, especially to the recipients (you get sick and your bills get paid) but it is not technically insurance. That's why I made the admittedly imperfect comparison to unemployment: getting money for your time (you're supposed to be searching for a job while receiving UI) is kinda like being employed but it's not actually the same as being employed. This is very similar to the quibble I have with the constant ACA confusion between health insurance and health care.

Interesting. But forgive me, I thought that Medicaid in many (most?) states operates like Medicare, whereby the federal gov't works with private insurance companies as the single payer to cover citizens 65 and over. I was not however aware that Medicaid didn't work this way.

EDIT: From Wikipedia:

Beginning in the 1980s, many states received waivers from the federal government to create Medicaid managed care programs. Under managed care, Medicaid recipients are enrolled in a private health plan, which receives a fixed monthly premium from the state. The health plan is then responsible for providing for all or most of the recipient's healthcare needs. Today, all but a few states use managed care to provide coverage to a significant proportion of Medicaid enrollees. Nationwide, roughly 60% of enrollees are enrolled in managed care plans.[2] Core eligibility groups of poor children and parents are most likely to be enrolled in managed care, while the aged and disabled eligibility groups more often remain in traditional "fee for service" Medicaid.

Admittedly, I know little about the legal definition of insurance vagaries.

 

[Gonad the Barbarian]

Here's another reality setting in.
http://orlandoweekly.com/news/the-perils-of-florida-s-refusal-to-expand-medicaid-1.1665144

 

[First]

Here's another reality setting in.
http://orlandoweekly.com/news/the-perils-of-florida-s-refusal-to-expand-medicaid-1.1665144

So tragic.

 

[sunzt]

I haven't followed this very closely but weren't there 40 million uninsured? Why haven't they all signed up?

One of the commentators in the LA times link provided this summary:


Look closely at the numbers in the article. It is 30 million
Now here is the Rand finding from the article in a list:
So we have 3.2 not yet counted + 3.9 counted = 7.1 exchange signups + 9 direct + 8.2 employer + 5.9 Medicaid
= 30.2 all additive and nothing should be netted out of those numbers