Conservative healthcare connector and wonk Robert Laszewski on the failure of Obamacare:
On Thursday, the Obama administration said they expect to have 10 million people enrolled on the Obamacare insurance exchanges in 2016. They further said they expect to sign-up only one in four of those still uninsured and eligible during the 2016 open enrollment scheduled to begin on November 1.
These are astonishing admissions.
In 2013 the Congressional Budget Office (CBO) estimated that the Obamacare insurance exchanges would enroll an average of 22 million people during 2016.
Given the original expectations how can we now not say this program is a terrible failure?
Note how he elides Medicaid expansion as a means of coverage and collapses all of PPACA to the Exchanges. This rhetorical trick is a kissing cousin of the discussion about total tax burden by income decile collapsing into a discussion of top marginal federal income tax rates by income decile.
Kevin Drum on the success of Obamacare:
In 2010, just after Obamacare passed, CBO estimated that the uninsured rate would hit 8 percent by 2016. This was based on the original law, but in 2012 the Supreme Court made Medicaid expansion voluntary and most red states opted out. In July CBO updated its projections to account for this, increasing its estimate of uninsured by three percentage points. The next CBO estimate thus projected that the uninsured rate would be 11 percent by 2016. So how does that compare to reality? In its most recent survey, the CDC estimates that in the first quarter of 2015 the actual number of uninsured clocked in at 10.7 percent, and that’s likely to decline to about 10 percent or so by the end of 2016.
In other words, once you clear away all the underbrush it looks like Obamacare is meeting or beating its goals.
The overall objective of PPACA is to reduce the uninsurance rate while at least reducing if not eliminating medical cost growth over the general rate of economic growth in the country.
The Exchanges are seeing less people because a lot more people are still on Employer Sponsored Coverage (ESI). The CBO originally projected that quite a few employers would eat the employee mandate penalty and dump ESI coverage to send their employees onto the Exchanges. That has not happened. PPACA is less disruptive than originally projected while still meeting or slightly beating its goals.
BGinCHI
Republicans lied, people died.
Obama passed HC reform law, people got much-needed coverage and their lives were made better.
Both sides do it.
Richard Mayhew
@BGinCHI: Of course, the optics of the policy matter not the policy itself, Obamacare was just so messy to pass and people are still shouting, so it must be bad….
1weirdTrick
He’s a subject-matter-expert… and yet there’re obviously so many cushy berths on the wing nut gravy train that Laszewski is willing to throw away his reputation for expertise just to tell the anti-Obamacare crowd what it wants to hear?
raven
No Joe, I like him even more now.
eta “Democrats should RUN on the Obama record”!
Elizabelle
Laszewski is a honk, not a wonk.
And what a tragedy that more states did not expand Medicaid. Would be a win-win all around, except for nasty “conservative” ideology.
dmsilev
@raven: Just saw that. It was the right decision. He’s done good as VP, but the stars weren’t aligned for a run for the big seat.
Patrick
Great posting!
I wish the media in DC was as clear in pointing out BS.
raven
@dmsilev: He doesn’t need this shit, he’s given enough.
dmsilev
@raven: And, as a bonus, we get to experience the anguish of the political press being deprived of their latest Shiny Object.
Keith G
@raven: Biden said, “The window had closed.” A very astute observation.
raven
@Keith G: He may not always be the most articulate but he knows what’s up.
Xantar
Even a lot of liberals seem to ignore the Medicaid expansion when talking about Obamacare, as if it only consisted of the health exchanges. Here in Maryland, half of the people who get new insurance are doing so through the Medicaid expansion. Why not crow about that in your numbers?
SarahT
@raven: Yup. Thanks, VP Biden – doing the right thing.
SenyoDave
@raven: A smart, down-to-earth guy. I think he would have been a good president 15 – 20 years ago, but he is correct that the window has closed. Hopefully he’ll do some serious campaigning in 2016 for the nominee. He’s a good guy to send to purple states, I think a lot of middle class folks can identify with him.
raven
Nice speech Joe.
Matt McIrvin
@Xantar: Maybe because it would make it clearer that many of the people who are still uninsured are uninsured specifically because of governors refusing to expand Medicaid. “Stop hitting yourself, Obamacare!” is not the winningest argument.
NonyNony
So now the follow-up question I’d like to ask is “why not”?
Was the CBO just making a “worst case scenario” judgment, or did they actually misjudge how good for the bottom line kicking the employees off onto the exchanges would actually be?
benw
@Elizabelle: The failure to expand Medicaid is like a greatest hits of all the shit that make me tear at my hair. From the awfulness of the Robert’s court and it’s individual conservatives, to the Democrats losing so much political power at the State level, to the wanton cruelty of self-proclaimed Christian politicians not helping the sick and needy for obviously ideological or self-interested reasons, to the fecklessness of the national media who refuses to cover this as the tragedy it is. Urgh.
srv
Seems like a lot of fuzzy math and moving the goalposts.
What were the original exchange vs expansion projections?
NonyNony
@Xantar:
While Republicans are angry about the existence of the social safety net, Democrats are embarrassed by it. They don’t tout their successes with expanding it because they’re afraid of the backlash from “regular voters” who see it as people getting “free stuff”.
Keith G
@raven: I often wondered if those outside of Biden’s circle who were stroking the speculation had watched the Colbert interview. That was a guy who looked like choosing a restaurant was too much of an arduous decision – and I say that not out of viciousness, but an acknowledgement of the pain that was so obvious.
jl
Thanks for a useful post debunking misleading analysis.
Also thanks to commenters for pointing out the end of the Biden drama of the millennium. I don’t want to guess whether Biden’s decision is good or bad. Who knows, maybe Gowdy will produce a photo of HRC signing a pact with SATAN!! at the hearing tomorrow and her campaign will go down in flames. Or, maybe not.
But, whatever, if the campaign needs Biden as savior, he can always be drafted later. Better for now to keep focus on HRC and Sanders contest (keeping mind that HRC still most likely to be nominee by far).
cmorenc
The central failure of Obamacare to conservatives is deeply ideological, that it’s a classic disruptive government intrusion into economic market decisions by insurers and health-care providers and decision options by private individuals, and therefore it cannot by ideological definition succeed, and so there’s an extremely strong bias to search for ways to frame data in ways consistent with proving those points. Unsurprisingly, that sort of analysis is prone to missing the forest for the selectively-chosen trees – and often not even choosing the most practically important aspects of the trees, because they’re focused on finding purported pests afflicting those trees and not whether the trees are nevertheless in fact healthy. And that’s without considering the deeply dishonest use conservative politicians make of such analysis by conservative-minded academics.
goblue72
@srv: Have you stopped molesting goats?
BillinGlendaleCA
@jl: Now the only question is if the media will stop including Handsome Joe in their polls.
Richard mayhew
@BillinGlendaleCA: has the hrc bids increased to the mid 90s yet
Gene108
@NonyNony:
I am guessing inertia. Businesses do not change unless something big forces a change and the PPACA has not been very disruptive.
Gene108
@cmorenc:
I thnk it is simpler. Obamacare taxes the rich a bit more and gives benefits to the poor. This is the worst thing government can do.
mkro
Robert Laszewski is the perfect example of how Libs can be very gullible. Ezra Klein named Laszewski “Pundit of the Year” a few years ago when the Exchanges launched. Even Charles Gabba still treats Laszewski like he’s a non-partisan healthcare wonk.
Elie
Yes, Richard, thanks for this informative post. As many have said, I just shake my head on the very real tragedy of State failure to expand Medicaid. I would go further — it is sinful — evil even, to withhold access to care to make a political point on the backs of those who can least fight back or have other alternatives. What kind of soul sleeps at night who would want that? Nevermind. We know. I have to keep reminding myself of the function of progressivism — the need to keep leaning into issues and courage and pride to keep moving the rock, keep putting our shoulders into it, expecting, even sometimes relishing the scars and sometimes the blood, on the many shoulders pushing this thing forward and up.
gelfling545
@raven: They certainly should. Running away from it in the mid-terms only got us a Republican Senate. Don’t support the President & then be surprised that his supporters don’t turn out for you. Hmmm. What could possibly be wrong there?