Can Obamacare Take Credit For Reducing the Nation’s Health-Care Bill?

Stephen Stromberg in the Washington Post: “A new analysis for the Urban Institute makes the best case for the law, which boils down to this: It sure doesn’t look like a budgetary disaster, and it might be doing more good than people realize, which would be very positive for the long-term federal budget.”

“The Urban report admits that it’s ‘impossible to estimate’ how much the ACA has helped reduce the growth of the nation’s health-care bill. But, the analysts argue, ‘it is possible that the ACA has played an unmeasured role in the recent spending slowdown and the lower projected future spending.’”

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“Updated CMS projections from October 2014 reckon that spending will actually be $2 trillion lower than the pre-ACA baseline and $2.5 trillion lower than than the initial post-ACA estimate. If you’re in the Obama administration’s correlation-equals-causation camp, that’s all you need to generate a talking point.”

“But not so fast. Lots of things might have kept cost growth down. In fact, the debate revolves around how much, not whether, the recession and slow recovery put downward pressure on health spending. How much credit you give the recession matters in part because, if the sluggish economy has been the predominant driver, health-care cost growth should shoot up again as the economy improves.”

“It’s still reasonable to cringe a little every time the Obama administration tries to take credit for the nation’s encouraging health-care cost numbers. But you should also cringe at critics who insist it’s a budgetary calamity.”

The Uninsured Rate Continues to Fall

Gallup: “The uninsured rate among U.S. adults declined to 11.9% for the first quarter of 2015 — down one percentage point from the previous quarter and 5.2 points since the end of 2013, just before the Affordable Care Act went into effect. The uninsured rate is the lowest since Gallup and Healthways began tracking it in 2008.”

Percentage Uninsured in the U.S., by Quarter

“While the uninsured rate has declined across all key demographic groups since the healthcare law fully took effect in January 2014, it has dropped most among lower-income Americans and Hispanics — the groups most likely to lack insurance.”

Jonathan Chait: “It is starting to look possible that this trend is not some random fluke that has happened six straight quarters but is somehow related to the enactment of Obamacare.”

Ted Cruz Bangs the Obamacare Job-Killer Drum

Danny Vinik: “On Thursday, CNBC published an interview with Senator Ted Cruz … Cruz demonstrated once again why it’s so hard to envision him as the nation’s top executive: He simply refuses to incorporate new facts into his understanding of the economy.”

“’The simple reality is millions of Americans are hurting right now under the Obama economy,’ Cruz said. ‘Yes, some jobs are being created, but not nearly as many have been destroyed. The rich, the top 1 percent, today earn a higher share of our income than any year since 1928.’”

“When Republicans first warned of Obamacare’s threats to the economy, they, including Cruz, repeatedly predicted events along that first reading … Instead, this has happened:”

“As you can see from the graph, there’s no point when Obamacare sent a ripple through businesses and stymied job growth. Even if you give Cruz the benefit of the doubt and assume he was imagining a hypothetical, Obamacare-less world, the chart shows why the GOP has had to mute its claims that Obamacare would destroy the economy.”

How Much Could the Supreme Court Damage Obamacare?

Washington Post: “New maps from the Washington Center for Equitable Growth help illustrate just how much is at stake, showing which states would be hit hardest if the Supreme Court struck down the subsidies that help people afford coverage on insurance marketplaces.”

“This map shows the distribution of people who are eligible to receive subsidies to help them buy insurance on ACA exchanges.”

“This map shows how a Supreme Court ruling would affect these exchange subsidies. The states in brown use federally run health care exchanges.”

“The Urban Institute has argued that such a decision would leave 8.3 million more people uninsured.”

A Trend Upwards for Obamacare Favorability

Gallup: “Americans’ views about the Affordable Care Act are more positive now than they were last fall, although overall attitudes remain more negative than positive. Half of Americans now disapprove of the 2010 law, while 44% approve — the narrowest gap since October 2013.”

Trend: Americans' Views of the Affordable Care Act

“Americans who are more likely to be affected by the ACA, including young people, lower-income groups and minorities, are at least slightly more likely than others to be positive about the impact of the ACA on their healthcare situations, although significant percentages of most of these groups still say the ACA has hurt them.”

A Revolution in Employer-Sponsored Health Plans?

Jason Millman: “As workers are increasingly asked to pay more from their own pockets for employer-sponsored health plans, there’s a big shift happening in how businesses are planning to offer health insurance.”

“About 6 million Americans with workplace coverage in 2014 received their health insurance and family health insurance through privately run health insurance exchanges, where employees can select coverage from a number of health plans from single person plans to family health plans — double the number from the year before, according to a new report from Accenture.”

“The exchanges work like the insurance marketplaces created under the Affordable Care Act, which provide a platform to shop and compare health plans. Unlike the Obamacare exchanges, however, the private-run exchanges don’t provide publicly funded subsidies to purchase insurance.”

“Obamacare’s looming “Cadillac” tax on high-cost health insurance plans could drive more employers to contain their health costs if the tax isn’t altered in a significant way before the levy takes effect in 2018.”

Obamacare Doomsday Cult Exists After World Fails to End

Jonahtan Chait: “As Obamacare continues to operate successfully, conservative elites have renewed their pleas for the party to develop an alternative beyond demanding the law’s repeal. The trouble is that anti-Obamacare dogma sits so deeply at the GOP’s core that any discussion of health care must pay fealty to their belief that the law has failed utterly. The Republican Party in the Obamacare era is a doomsday cult after the world failed to end. Its entire analysis of the issue is built upon a foundation of falsehoods.”

“This is the reality that the entire Republican Party has failed to come to grips with … Obamacare set out to change those things, and it has worked.”

“Michael Tanner, a health-care analyst at the Cato Institute, has a column for National Review usefully summarizing the most current iteration of anti-Obamacare talking points … There is one … indictment of the law that Tanner makes, and it’s true. ‘The law remains extraordinarily unpopular, with opponents topping supporters by nearly 11 percentage points, according to the latest Real Clear Politics average.'”

So, “their sole remaining refuge is an argument about its perception. It’s true: … Those myths still hold enormous sway over public opinion. Far more Americans believe Obamacare has death panels, which is false, than believe its costs have come in under projections, which is true. Conservatives have won the propaganda war over Obamacare. The trouble is that they think this is an indictment of Obamacare, when in fact it’s an indictment of them.”

An Obamacare Fallout from Upcoming Insurance Rules?

National Journal: “Next year, Obamacare insurance rules will start to apply to a new pool of small businesses, and experts say that could lead many of them to take a look at insuring themselves—that is, stepping outside of the health care law’s market and supplying their own health coverage. If they do, the fallout could be significant.”

“The worry is that the regulations will drive companies with younger and presumably healthier workers to take a hard look at self-insurance. If they decide to go that direction, it would leave companies with older and sicker workers in the insurance risk pool, which could drive up prices.”

“Just as the law’s supporters worried that if too few young people signed up for coverage in the individual market, it would drive prices higher, the same principle would apply for small businesses, said Larry Levitt, vice president at the Kaiser Family Foundation.”

“With an estimated 40 million Americans working for firms with 100 employees or less, per the Census Bureau, it is a significant market that could be affected.”

“It has a real negative effect on small businesses that are buying insurance,’ Levitt said, ‘and it will feed negative perceptions of the law because it will certainly be pinned on Obamacare.'”

Obamacare Prevented at Least 50,000 Deaths

The Washington Post fact checks President Obama’s claim that 50,000 have not died in hospitals because of the Affordable Care Act and finds it largely true.

“The 50,000 number is derived from a study, released on Dec. 2, 2014, by the Agency for Healthcare Research and Quality, an arm of the Department of Health and Human Services… The numbers might seem large, but the research seems solid, according to experts we consulted, and it is based on a review of an extensive database. The results likely reflect work that predated the ACA but at the same time the ACA has spurred even greater cooperation among hospitals. Since the president is using a figure more than a year old, it is likely understated — unless, of course, the interim number for 2013 turns out to be overstated.”

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Obamacare Enrollees Aren’t Swamping the Nation’s Doctors’ Offices

Sarah Kliff: “About 14 million Americans have gained health coverage since Obamacare’s insurance expansion began in 2014 — but those new enrollees haven’t swamped the nation’s doctors’ offices, new research shows.”

“New data from 16,000 providers across the country, pulled by the medical records firm AthenaHealth, shows that requests for new appointments just barely edged upward in 2014. The proportion of new patient visits to primary care doctors increased from 22.6 percent in 2013 to 22.9 percent in 2014.”

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“One reason the Obamacare news isn’t a surprise: it looks similar to what’s happened with previous insurance expansion. Since Massachusetts expanded coverage in 2006, annual surveys by the Massachusetts Medical Society haven’t shown any clear pattern in changes to care access.”

“And if you go even further back in history, you see the same thing happened with Medicare.”

“What all these programs have in common: they are big ideas that fundamentally change the health insurance system in the United States.”

“But in practice, these programs are relatively small: each only insured a small chunk of the population. Even though they’re remaking American health care, they’re doing so in a small, slow progression. That helps explain why none of these coverage expansions have overwhelmed doctors, despite our expectations.”


Obamacare Signup Period Produces 36,000 Sign-ups

The Hill: “About 36,000 people have signed up for ObamaCare plans through March 29, during a special extended enrollment period, the administration announced Wednesday. ”

“While the administration had not provided an estimate of how many people would sign up in the extra period, which began March 15, the enrollment number is relatively small.”

“ObamaCare sign-ups expert Charles Gaba had estimated that 220,000 people would have signed up by March 29. ”

The deadline is April 30.

What Health-Cost Slowdown?

Drew Altman in the Wall Street Journal: “National spending on health care and insurance premiums has risen at historically low rates in recent years. But, as the chart below shows, even when spending and premiums experienced record-low growth in 2013, only 3% of Americans said health costs had been rising slower than usual, and 52% said they had been growing faster than usual. The American people are not out to lunch; their view of the problem of health costs is very different from that of experts.”

“With premiums, deductibles, and drug costs rising at a time when wages have been relatively flat, it’s no wonder Americans haven’t felt relief from the slowdown in health-cost growth, even if their premiums have been rising more slowly than in the past.”

“And Americans overall don’t care as much as experts do about improving quality and eliminating unnecessary care. In general, people think that quality is good and they want more care not less.”

Altman recommends that lawmakers should place “more emphasis on costs and the affordability of coverage than expanding coverage, and on consumer protection and consumer information.”