A bit of bad news. The CBO has reduced the number of people it projects that will be covered by the PPACA exchanges:
The Congressional Budget Office study said that 13 million people are likely to purchase policies through the Affordable Care Act this year, down about 8 million from estimates the agency made early last year. That’s based on updated enrollment figures through last month.
The Department of Health and Human Services had already flagged the lowered expectations last fall, predicting just 10 million customers signed up and paying premiums through online insurance markets by the end of 2016.
Other experts (like Charles Gaba) had always had significantly lower projections than the CBO.
Now the good news:
The uninsured rate is at record lows and will continue to decrease as Medicaid expansion continues and there is a slow uptick in Exchange enrollment. The biggest driver of the CBO drop is that they had been projecting for years that the Exchanges would cannibalize quite a bit of private coverage provided by employers. They thought that Employer Sponsored Coverage (ESI) would be less popular as employers could dump people on the Exchanges and pay employer mandate fees instead of premiums. That has not been happening.
So the short take away is that the law is achieving its goals with even less disruption than previously projected.
gene108
Once something becomes the norm it is hard to change.
Also the thought of paying a fine to the government or generally running afoul of the Feds scares a lot of business owners.
japa21
That plus the increased in employed people now getting insurance through their jobs. Not sure if the CBO took into account the extent of increased employment our if they discounted it based upon their assumption that employers would dump employees onto the Exchanges.
One of the reasons I think employers did not do so is that, as the unemployment rate decreased, they had to compete a little harder for employees, and telling people they would have to go through the exchanges, with all the imagined difficulties (harped on by the right) that went along with that would not be conducive to hiring.
japa21
@japa21: And to add, the most important data point is the number of uninsured. I expect the right to crow about the decreased projection, but the left better just crow about the uninsured rate and how it would be even lower if so many states were not governed by sadistic Republicans.
Punchy
They mis-estimated by 8 mill? That’s one hell of a miss.
In OT news, Liberty Uni pres Falwell–king of conservative, Christian, family values–has endorsed thrice married, serial philanderer Trump. My Hypocrisy Meter just exploded into 21….er….13 million pieces.
NonyNony
I suspect that CEOs of companies like to have the company foot the bill for their own insurance and have the company’s HR department deal with the administration of the plan, rather than buying it on the individual market or the exchange and having to deal with the insurance company themselves.
(Cynically speaking – IME the CEO always gets all star treatment by both HR and by the insurance company the firm contracts with. The insurance company knows it can screw the plebes, but upper management needs pampering lest they lose the entire contract because the CEO gets irritated at the support person and has HR find another company in a fit of pique…)
WarMunchkin
So, uh, is the next major “test” of the exchanges going to be the next crash?
Brachiator
@Punchy:
The key thing here is the political implication of a major evangelical leader endorsing Trump. This may be more valuable than Sarah Palin crawlin’ up out of her lair. This may help Trump in South Carolina.
You know that Cruz was hoping to get an endorsement like this.
Also, this health insurance news is quite interesting. Does it matter that fewer people are getting insurance through Exchanges as long as they are getting insurance from somewhere? Have the option of Exchanges increased the number of plans that offer minimum essential coverage, as opposed to fig leaf plans that may have been insufficient?
catclub
@WarMunchkin: Being able to get insurance after losing one’s job will become normal. COBRA was already there, that is time limited.
lowercase steve
Great on the uninsured rate, but we do need to shift people out of employer-provided health insurance and on to the exchanges to make headway on things like labor mobility and coverage gaps for the laid-off/temporarily unemployed. And of course the route to single payer through the public option doesn’t work if nobody is on the exchange!
I know there is a “Cadillac tax” that will eventually come online and others have talked about ditching the employer mandate (which is counterproductive but rather marginal in its actual effect) but what else is planned/discussed on this front?
Poopyman
So the employment projections exceeded expectations by how much? Surely not the whole 8 million, but certainly a healthy fraction, no?
@Punchy: So how does the head of a 501c3 organization (i.e. Liberty U) get to endorse a political candidate without any legal ramifications?
(Yeah, I know. Mostly rhetorical, sadly.)
Starfish
@lowercase steve:
A lot of the exchange plans that are available in my local market are the high deductible plans. The employer offering a plan to our household is still offering a PPO option this year; but next year they are going to only offer a high deductible plan. At that point the things offered on the exchange may be more comparable to the plans offered by the employer.
I still do not like the high deductible plans because there is no market transparency to know the cost of anything, and most people opt to ignore their medical needs and have no way of doing a cost benefits analysis.
Doug R
@Brachiator: I don’t think his bible has Matthew 6
PurpleGirl
I have a friend who lost her job in October of last year. She began working on a per diem basis. Expecting to working that way for a longish amount of time she looked into getting health insurance from the Exchanges instead of taking COBRA. She found a policy that was better than what she received from the hospital where she had worked. While it’s hard working per diem, she’s pleased to have better health insurance right now.
Cacti
None of this will matter once President Sanders bully pulpits single payer into existence.
lowercase steve
@Starfish:
I don’t think you are allowed to enter the exchange if your employer offers insurance (even crummy high-deductible insurance) so I think a lot of people are getting stuck with employer insurance and are unable to shop around for a better plan for their needs.
JPL
@Brachiator: Since the uninsured rate has fallen, it does seem likely that they are getting health insurance from someplace else.
As far as the major endorsement for Trump.. I found this gem in the Washington Post
“In my opinion, Donald Trump lives a life of loving and helping others as Jesus taught in the great commandment,” Falwell said.
What great commandment is he talking about????
Mike J
@Cacti: Front page of TPM says Bernie singlehandedly wrote the no good bad evil ACA that he’s going to repeal and replace.
Mike J
@JPL:
Love thy neighbor as thyself.
Matt McIrvin
If the numbers had been in line with projections, the objection would be that the numbers were cooked because Obamacare was just taking away people’s nice employer insurance and forcing them onto the exchanges instead.
Marmot
Roger Moore
@lowercase steve:
Not really. You get most of the benefit of the exchanges as long as employees know they’re there and it will be possible to get coverage if they lose their job. There will be a small gap between when they leave their job and when coverage on the exchange starts, but that can be covered by COBRA or similar programs.
JPL
@Mike J: Depends on the neighbor, I suppose.
Mike J
@JPL: Trump saves his lovin’ for young eastern European women.
EriktheRed
So where’s srv, now that Richard has weighed in on the issue?
BlueNC
@lowercase steve: I don’t think you are allowed to get subsidies. You can, however, decline employer-provided insurance and get your own on the exchange. I think.
Matt McIrvin
@Marmot: For bigger and richer companies particularly, they could be using their employee health plans as an incentive to attract the talent they want, as they always have.
Richard Mayhew
@lowercase steve: Everyone is allowed on the exchange. You just might not be able to get a subsidy.
Someone whose employer or a family member’s employer (the family glitch) offers “affordable” single individual coverage is ineligible for subsidy. They can still buy an Exchange policy.
Marmot
@Matt McIrvin: That’s a good answer — saw it upthread too. Remember right after the recession when companies were saying they had cut hiring because workers were too unskilled? Boy, those were fun times.
NonyNony
@JPL:
Randy P
@Mike J: Which Trump exemplifies with his cries to bomb civilians, eject legal immigrants, close the gates against refugees, and beat up people in his rallies who look like they might disagree with him.
How much more loving can you get?
NonyNony
@Randy P:
None of whom are people that Falwell would consider to be “neighbors”.
Falwell likely reads the parable of the Good Samaritan and envisions the victim as a white guy dying in a ditch, then there’s two non-white guys (likely Jewish in his mind) who pass him by before the Samaritan – who he probably envisions as a white guy – comes along to help him out.
Divorced from history, the parable reads like a general call to help out other people in need. But that’s barely what it is about. It’s a commentary on how actions are what make you a good person, not your status or your “holiness”. In a modern translation it would be better read as two devout Christians ignoring the guy in the ditch and then replace the Samaritan with a Muslim guy/gal who helps the dying guy.
Roger Moore
@JPL:
The Golden Rule (wingnut version): He who has the gold makes the rules. Alternatively: do unto others before they do unto you.
Jacel
That’s great news. I’m glad to hear those earlier projections honestly took into account the anticipated disruptive scenario of companies en mass dropping employee insurance, which sure sounded likely at the time. Glad to hear the actual transition has been smoother than anticipated, even though the only Republican takeaway from this news will be that Obamacare missed its numbers by millions of sign-ups.
lowercase steve
@Roger Moore:
Have you ever been on cobra?….$600+/month is not something a lot of people can afford while in an employment gap.
Brachiator
@JPL:
I think it’s in the recently discovered Gospel of Donald. It talks about Supply Side Jesus, who was guided by the Holy Hand of the Marketplace. “I gots mine, and I gots yours, too! Loser!”
lowercase steve
@Richard Mayhew:
Hmm. I guess another problem is that while the employee contribution might be removed from your pay stub, the employer contribution (basically the fact that your wages are lower than they would be if the company didn’t provide insurance) is unlikely to be returned to you through larger future wage increases relative to the counterfactual.
So there are not really many compelling reasons to enter the exchange.
Brendancalling
The absolute WORST part of my impending move to Tennessee is going to be losing Medicaid and going back to those awful fucking exchanges, and the bullshit expensive high-deductible plans they offer, none of which come close to Medicaid in terms of benefits.
Ugh. The fucking worst. I am dreading the whole thing. No surprise to me that enrollment is down. I’d just as soon go without, and I was an ACA supporter.
Richard Mayhew
@Brendancalling: that is not what the CBO is saying.
There initial model had the % of ppl covered by ESI drop and a lot of those people shidt coverage from ESI to Exchange. The switchers on net would have no impact on uninsurace rate but would increase number of ppl on Exchange.
It was a reasonable conclusion from a reasonable model. It was wrong.
ESI coverage % has gone up not down. CBO just updated their model with reality.
As far as total enrollment, 2016 enrollment has surpassed total 2015 enrollment even with a week left and policies being scrubbed from the count a month or two earlier.
Data does not support your rant
jl
If RM still here, I wonder what he thinks is best measure (covered at time of survey, at least X months coverage over last year, covered over last year, or something else?) and source for overall rate of coverage?
That is the most important number. I can;t figure it out from data in the links. I think it needs to get under 10 percent (including all private, Medicare and Medicaid and other public plans) with no insurance to start capturing most benefits of universal coverage, assuming can keep ‘churn’ under control.
Richard Mayhew
@jl: Gallup is pretty good and minimal lag for adults 18 to 64, Census CPS is very good data but big lags… Most measures have the uninsurace rate between 10 and 11.5% depending on lag and population definition
jl
@Richard Mayhew: Thanks. That seems like the bottom line very good news for PPACA. I didn’t realize the uninsured rate has gotten that low. I need to refamiliarize myself with the measurement issues and sources and draw some graphs. I wonder how much variation there is between different measures of coverage.
goblue72
I’m just gonna quote Atrios on this one –
nastybrutishntall
The marketplace is a nightmare for anyone trying to become middle-class who earns slightly too much for subsidies.
Live in an expensive housing market? Live in a high medical cost area with little insurance competition? Have to pay child-support but have no children living at home full-time? The exchange will make you eat beans and rice just so in case of a real medical emergency you pony up your savings or your home and eat salty tears.
I’ve stuck with my old BCBS grandfathered plan because otherwise I pay 100% more for a 50% higher deductible and more or less the same benefits. The ACA only works for the poor and for the wealthy. Trump’s supporters are from those barely-middle-class like me getting screwed like I am who have a less-well-developed knowledge of history and the false promise of violent revolution.
As much as I think Krugman is right about the energy that redoing the ACA into Medicare for all would cost a Sanders administration, at least Bernie is acknowledging that there is a sizeable group being fucked over by the law. Yes, at least preexisting conditions got the ax. But if you can’t afford the plans you are legally entitled to have, it’s cold comfort.
DCF