In the debate over Obamacare, which came to a legislative impasse as ignominious as its origin last night, there’s a tendency of Obamacare supporters to dismiss or denigrate the victims of the Affordable Care Act. This reflex was on full display in a column by John Harwood for CNBC this week. This is the headline: “Republicans wage 7-year war against Obamacare on behalf of a tiny fraction of aggrieved Americans”
The problems in the individual market are big enough that Harwood can’t completely ignore them, but he’s very willing to tell you they don’t matter. The number is small, the people aren’t that sympathetic, their hardships are a small price to pay.
President Donald Trump spoke for his party last fall as he ripped the Affordable Care Act for pushing rates ‘through the sky.’ As Republicans crafted a replacement this spring, he promised ‘much lower premiums and deductibles.’ In reality, just a tiny fraction of Americans — disproportionately young, male, healthy and middle-to-high income — has seen costs sharply increase because of Obamacare. Liberal and conservative experts alike place the number well below 10 million people — 3 percent or less of the population.
Harwood is right that the individual insurance market, which is far smaller than the employer-based insurance market, disproportionately shoulders the burden of Obamacare’s attempts to expand insurance coverage. He’s right that there’s a smaller sliver of unsubsidized young-and-healthies within it that shoulders it most disproportionately.
And, yes, many of those people, both with and without subsidies, are aggrieved. With very good reason.
Far from a privileged group of fat cats, they are small business owners, middle-class families, and contract workers trying to make things work without the tremendous tax advantage given to health insurance provided by employers. With the system (actually!) rigged against them, they nonetheless did the responsible thing: buying insurance so they wouldn’t turn into burdensome free-riders. In return, these people were lied to repeatedly, told they would not face any of the consequences they have faced, made to bear the brunt of both Obamacare’s costs and broken promises, and now they’re denigrated for daring to point out they have been hurt.
The Individual Market Proves Obamacare Is a Lie
The U.S. Department of Health and Human Services studied premiums in the individual market, finding they doubled over four years on the federal exchange. One third of American counties have one or zero insurers “competing” on the individual market for their business.
Let’s recap the promises of Obamacare. President Obama said families would see a $2,500 decrease in premiums. Obama said if you liked your plan and doctor, you could keep your plan and doctor, and anyone who suggested otherwise was lying. Obama said the exchanges would bring increased competition and lower prices. Obama said mandates would bring better coverage, but not higher costs. He even said the exchanges would make it easier to be in the individual market. Obama, and everyone who repeated him, was wrong.
These things quite obviously couldn’t be true for everyone at the same time. Those who pointed this out were at best called stupid, at worst, liars and racists. What they really were was right.
The individual market puts the lie to Obamacare. It is the starkest illustration of its broken promises and costs. For those more comfortably ensconced in the employer-based health insurance market, premiums and deductibles have gone up and options have disappeared. This is still a violation of Obama’s promises, though not as dramatic. Many who have never been in the individual market— I have, pre- and post-Obamacare— actually have no idea what it looks like.
In his column, Harwood raises the specter of sky-high deductibles affecting the “very sick” under Obamacare replacement plans. I have news for him. Many already have five-figure deductibles, and they don’t affect only the very sick. They are making the very expensive Obamacare plans of middle-class families nearly unusable.
In fact the Affordable Healthcare Act accelerated a trend toward higher deductibles. Deductibles are up 67 percent in the group market since 2010, and 90 percent of exchange purchasers have high-deductible plans. But there are fewer than 10 million of them. Who cares?
Essentially Everyone Who Will ‘Lose Insurance’ Won’t
Let me tell you the tale of another couple million “victims” in the Obamacare replacement game. These “victims” matter a great deal to media. We hear about them all the time, and not just to dismiss and downplay their experiences. But they don’t exist. They literally don’t exist, and the hypothetical loss they are supposed to take under Republican replacement plans doesn’t exist, either.
Let me explain. You’ve heard the talking point that 22-24 million Americans will “lose” insurance coverage under the Republicans’ Obamacare repeal plan. Wow, that does sound like a big, bad, deal, and the Congressional Budget Office said it, so it must be true.
But between 5 and 7 million of those people aren’t real. How is that possible? Because when determining how many people might lose coverage under an Obamacare replacement plan, the CBO must first establish how many people have coverage right now under Obamacare. That’s easy, just look at the enrollment numbers, right?
Wrong. Despite the fact that objective reality offers a very clear number of people covered by Obamacare on the exchanges, the CBO uses its own, incorrect, outdated estimate of how many people it thought might be covered by Obamacare on exchanges by now.
CBO’s estimates have always drastically overstated how well the individual mandate would increase coverage. The number CBO is using for “how many people are covered under Obamacare” therefore includes 5-7 million people who were never covered under Obamacare, aren’t covered by Obamacare now, and cannot therefore lose insurance as a result of Obamacare replacement. This number is yet another indication of ACA’s failures, not the failures of a hypothetical replacement.
This is like the fantasy football league commissioner plugging in 46 TDs for his QB stats because that’s the number he thought his draft pick would chart, even if the actual number is 25.
Those touchdowns aren’t real, no matter how hard he sticks to his prediction. These Mythical Americans who are to suffer hypothetical repercussions at the hands of Republican replacement plans are nonetheless given all the credence in the world in the health care debate. Even if they existed, they are a tinier fraction of aggrieved Americans (as Harwood might describe them) than those hurt by ACA.
Yet they are in every media mention of every Obamacare replacement. The remainder of the 22-24 million number is made up of people who CBO says would willingly forgo coverage if not forced to buy it by the government. That’s still not “losing” coverage or having it “taken away,” as media reports disingenuously say, but at least those people actually were covered at some point under Obamacare.
This is not to say there would be zero Americans who would lose in an Obamacare replacement scenario. Of course some would, and plenty of people benefited under the Affordable Care Act even as the individual market has tanked. Every single public policy change has trade-offs. It was the inability of the Obama administration to admit that simple fact, and the eagerness of media to view his promises sans skepticism, that left many so “aggrieved,” as Harwood puts it.
Last night, we witnessed a failure by another political party to honor its promises to those people. They are still there, there are still millions them, and they are still aggrieved. But hey, at least the 5-7 million people who never bought insurance under Obamacare are safe.