The Widdershins

Some additional facts on how Obamacare has helped healthcare

Posted on: July 16, 2014

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No it’s not perfect but despite all the protestations to the contrary and despite having been done away 30 or more times by the Republican House, it’s still around.  My preferences would have been either single payer or Medicare for all, but, as they say, “it is what it is”.  And what it is, is something that appears to be working.

I read this article in the New England Journal of Medicine which looked at the A.C.A.  through a number of different scenarios in how people obtained medical coverage and what they got.

We all saw the numbers after the open season closed and eventually over 8 million people enrolled in the health insurance exchanges (state and Federal) and that number even beat the CBO earlier estimate.  The NE Journal article chose to look at aspects of Obamacare that have been either overlooked or glossed over.

In assessing the record of the ACA to date, we comment on enrollment not only through the individual marketplaces but also through other critical vehicles for extending coverage: the requirement that private insurers cover children of enrollees until the age of 26 years, the expansion of Medicaid eligibility, new insurance-market rules that enable people to more easily buy plans directly through insurance companies outside the individual marketplaces, and marketplaces created for small businesses, known as the Small Business Health Options Program (SHOP). We also report on early survey data about recent trends in rates of insurance since the passage of the ACA.

(Me here)  They have a handy-dandy pie chart which you can see here.  It was too big to put into the post.

As the article states, parts of the A.C.A. actually began in 2010.  One of those parts was the requirement that insurance companies/plans having dependent coverage allow parents under those plans to keep their children on the plans until age 26.  As the article states:

Last year, a Commonwealth Fund survey showed that 7.8 million adults between the ages of 19 and 25 years were enrolled in a parent’s plan — and that most of these enrollees would not have been eligible to do so before the passage of the law. Federal surveys suggest that the number of young adults without health insurance has declined by 1 million to 3 million since the provision took effect. The young-adult provision has been popular across the political spectrum. The Commonwealth Fund survey showed that young adults who identified themselves as Republicans were enrolled through their parents’ policies in greater numbers than were those who identified themselves as Democrats. (Me again:  of course that says something about the Republican parents too, no?)

The next item the article discusses is the fact that with the A.C.A. came new coverage provisions on companies who sold individual plans, whether through an exchange or otherwise.

Insurers selling health plans in these markets can no longer set prices on the basis of health or exclude coverage of preexisting health conditions, and they are limited in what they can charge older adults as compared with younger adults.   In addition, all plans that are sold in these markets must meet comprehensive benefit standards.

And further help individuals making decisions:

to aid consumer decision making, health plans must be sold at four distinct levels of actuarial value (i.e., the share of medical costs covered on average). For example, on average, bronze plans must cover at least 60% of medical costs, silver 70%, gold 80%, and platinum 90%.

The 2nd thing the A.C.A. did was to create the individual exchanges, which sadly, most states chose not to do.

And thirdly,

the ACA substantially expanded eligibility for the Medicaid program. The 2012 Supreme Court decision made state participation in the law’s expansion optional. As of now, 28 states and the District of Columbia are moving forward on expansion, including 6 states that are pursuing customized approaches requiring federal approval.

The article says that one of the criticisms the “anti” people have thrown out is “Okay they signed up.  How many have paid premiums?”  Again from the article:  “State and federal officials, using data provided by insurance companies, estimate that 80 to 90% of enrollees have paid their first month’s premiums. But it will be important over time to assess whether individuals using the 51 marketplaces pay their premiums each month.”.    Another important fact in whether individuals will keep paying their premiums is the amount of subsidy they receive.  “The fact that 85% of people who selected a plan during open enrollment were eligible for premium subsidies will undoubtedly influence this outcome, since the subsidies dramatically lower their premium contributions.”  [Note:  for me not so dramatically lowered, but still lowered]  Other factors will contribute to this also such as cost-share (deductibles and co-pays) and whether or how much insurance companies restrict the networks they put these plans into.

The article further goes on to state that the 8 million number is probably just the tip of the iceberg.

The CBO projects that 25 million people will have insurance through the marketplaces by 2017. Although ongoing outreach efforts will be critical to inform those eligible about their coverage options, it is easy to see how the current number will grow. There will be annual open-enrollment periods, with the next one scheduled for November 2014 through February 2015.  Individuals can also enroll at any time they lose insurance as a result of an important life event, such as marriage, or a job change. An estimated 4 million people may gain health insurance this way this year during the months between the open-enrollment period. (This would also apply to someone who is moving from one state to another, like me if I were to return to Louisiana.  I could then go back on the exchange to pick a plan in  La.  I wouldn’t be counted as a new enrollee but I could use the exchange again because of a “life-changing event”, i.e. relocating to another state.)

Another method or avenue of enrollment was discussed and that was individuals who enroll for coverage, but outside of the marketplace/exchanges themselves.  An individual isn’t eligible for subsidies going this way but they are still getting coverage.  And these are probably individuals who wouldn’t be eligible for subsidies, hence not using the exchanges.

The law’s new regulations affecting private health insurance that is sold to individuals and small employers in the United States protect consumers and small companies, whether they buy plans in the new ACA marketplaces or outside them in traditional insurance markets. This creates another entry point to coverage for people who previously would have faced exorbitant premiums or been shut out of the market altogether because of age or preexisting health conditions. And of course, the individual mandate creates added incentives for individuals to sign up. Recent CBO estimates project that 5 million people may gain coverage this year directly from insurers.

Lastly come the numbers for those who were able to enroll in Medicaid.  As sad as it sounds and it is, we know the governors or legislatures of some states have refused to expand medicaid eligibility even when it is covered 100% for the first three years.   Some politicians are doing it for presidential aspirations (snort!), others, who knows.  But here are some facts:

In analyses of the success of the ACA in reducing the number of uninsured Americans, the Medicaid provisions of the law are likely to prove to be as important as its private insurance-market programs. The expansion of eligibility for Medicaid to people with incomes up to 138% of the poverty level is the largest such expansion since the inception of the program in 1965. Before this expansion, only people with low incomes who fell into certain categories (children, parents, pregnant women, people with disabilities, and those >65 years of age) were eligible. The expansion in Medicaid eligibility is also well financed from the perspective of the states. The federal government is covering 100% of the costs for most states through 2016, before gradually reducing its contribution to 90% for all states by 2020. This new financing translates into an infusion of federal dollars into states to the tune of $800 billion through 2022.

The sad thing is, it’s in these states where the medicaid expansion was blocked that you have people who are essentially cut out of obtaining any type of healthcare.

In such states, people with incomes at or above 100% of the federal poverty level can apply for subsidies for private plans in the marketplaces. But those with incomes below the poverty level cannot apply for such subsidies, since drafters of the ACA assumed that the poor would be eligible for Medicaid. In the states that have not yet expanded their programs, nearly 5 million uninsured people with low incomes are expected to be left out of the new coverage options this year.

And yet:

Despite these facts, 6 months after the launch of the coverage provisions of the ACA, 6 million people had enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). This tally includes people who were found to be eligible as they sought insurance through federal and state marketplaces or through other means. Many individuals who went to online marketplaces were informed of their Medicaid eligibility. Consequently, this figure also includes people living in nonexpansion states who were found to be eligible under their state’s preexisting Medicaid and CHIP programs. The CBO is now projecting that new enrollment in Medicaid and CHIP will reach 7 million this year and 13 million eventually. Even with uncertainty about state participation, this means that 46 million people — or 17% of the nonelderly U.S. population — could be enrolled in Medicaid or CHIP by 2018.

The authors sum up by stating that including all possible scenarios: young people under 26 on their parents’ plans, those who obtained insurance through the market place exchanges, those who qualified for expanded medicaid, those who bought individual policies directly from an insurance company and even those in states which did not expand medicaid but were found to be eligible under existing state medicaid guidelines, these number total up to over 20 million people who have benefited from the A.C.A.  ( You can see the chart here)

I think when you look at these numbers you can see that the A.C.A. is at the least working in getting coverage for individuals, minus those of the poor in states that did not expand medicaid.  The important aspect is that these are now individuals who will be seen by doctors or clinics before they have a health crisis.  They won’t be the diabetics who show up to the e.r. with a blood glucose of 300 or 400 or higher.  They won’t be the individuals with hypertension that is uncontrolled who go to an e.r. after having suffered a stroke.  They will be seen and treated while still in a preventative stage before they suffer a health crisis.  That lowers medical costs for them and it helps to lower the overall cost of medical care for the country.  There is no way to deny that this is a good thing.


14 Responses to "Some additional facts on how Obamacare has helped healthcare"

The other thing Obamacare seems to have accomplished is introduced US-ers to the point that government has a role to play in providing medical care. Why this was a difficult concept, I don’t know. What with Medicare and the VA taking care of nearly half of the US, you’d think that was obvious. But, whatever. Any port in a storm. And if people here have finally figured out that government is a workable way of paying for health care — we’ve definitely got plenty of examples that nothing else is! — then that’s pretty big.

I’m a big skeptic on how Obamacare will play out in practice for a lot of people, i.e. once they actually have to use it. But opening people’s minds to how to pay for it is still a big deal.

quixote said: The other thing Obamacare seems to have accomplished is introduced US-ers to the point that government has a role to play in providing medical care.

Exactly! And besides Medicare and VA, don’t forget Tricare for the military and dependents and then also for military retirees.

I’m a big skeptic on how Obamacare will play out in practice

I have yet to use my BCBS-AL plan for anything other than prescription meds. I took the Platinum plan only because I could afford it this time around. It’s supposed to basically be a 90/10 setup. We’ll see how that works. I know that if I have to go to the hospital I have a $150 copay for the first five days I’m in the hospital. So, I had to end up taking out an indemnity plan that pays me so much for each day I’m hospitalized. They don’t offset each other but it would make a dent in that copay.

Oh and thanks for commenting Quixote. I was so afraid no one was going to write anything in reply. 😉

Oh quioxote you’ll love this…I didn’t see it until after I had written the post.

Blue Cross Blue Shield of Louisiana, the state’s largest provider, is proposing rate increases of between 18.3 percent and 19.7 percent for policyholders in its Blue Saver, Blue Max and its Multi-State individual health plans

In a statement, Blue Cross Blue Shield of Louisiana said the biggest factor for proposing rate increases was the high utilization of health services used by subscribers. “Right now, at Blue Cross and Blue Shield of Louisiana, we are seeing that more people are accessing more health care services than we expected and our claims are higher than they have been in previous years.

But then what BCBS-LA fails to mention is another part of the ACA will reimburse ins. companies for higher than expected claims…sort of like a reinsurance plan. From the NEJ article:

Another factor that will militate against dramatically increased 2015 rates is the risk-sharing programs of the ACA, including the so-called transitional-reinsurance and risk-corridor programs, which protect insurers and consumers against dramatic premium hikes.13 Carriers with higher-than-expected claims will receive reinsurance payments, for example. This factor alone reduced premiums by 10% in 2014 and will continue to play an important role in limiting premium increases in 2015.

Methinks if/when I do make my move back to La, I’ll be keeping a Bama drivers license and just say I’m back down there for an “extended stay”. I haven’t seen anything with BCBS AL so far that indicates they are going to go for double-digit premium increase.

Totally OT, but did you see this?? Woody Allen made this for PBS before Watergate – about Nixon. PBS never aired it because they were afraid it would endanger public funding. And it’s a holy cow!

@DYB: Off topic is good. Right now, anything is good. 😆

How have you guys been? I’ve been MIA a lot. Just busy on and off. When busy, really busy. Plus last week I got a horrible sunburn – and bronchitis! So that was fun! But, to stay on topic, I did have health insurance and was able to finally use it!

DYB@6: Things have been muddling along here at TW. Chat is gone on vacay and she’ll be back toward the end of next week.

Sorry to hear about the sunburn and bronchitis but glad you had the health insurance. Hope it was helpful for you. 🙂

Fredster, very good post! Sorry I had to work long hours today. That LA Blue Cross story is not good. That is a large increase. I hated Blue Cross when we had them here. We have Kaiser, which is far from perfect but 100x better here than BC.

We are very happy to have Laker able to be on our insurance through 26. Also the no previous condition thing. With his muscular dystrophy, he would be stuck applying for mediCal (Cali medicaid), and we don’t want that.

annie@8: I cannot even begin to imagine what “claims increase” BCBS-La had to warrant such an increase. And naturally in La, the state ins. commissioner has no power to block it. He says he tried to get the lege to give him authority to roll those things back and the lege said no. So really what good is he? And we’ve only had three of the previous Ins. commissioners land in prison. 🙄

annie said: With his muscular dystrophy, he would be stuck applying for mediCal (Cali medicaid), and we don’t want that.

Although I bet medical is heads above medicaid in other states (esp. in the south), yes he’s definitely better off to be on y’all’s insurance.

To expand on quixote’s comment @1, ACA has also actually introduced some Republicans to the idea of single payer. David Frum (Bush’s speech-writer, currently senior editor at The Atlantic) was on Bill Maher a few weeks ago and they were discussing the AVA scandal. Frum started saying: And why are there all these different channels for healthcare, separate for AVA, then Medicare then blah blah blah; it’s so confusing. Bill Maher was like: So you’re saying you want single payer?? Hello!!! Frum paused and looked kind of startled. Then said: Yes, I suppose so.

DYB @12. 😀 I’ve heard of similar happening elsewhere, too. Some Republican running for State Senate in PA? FL? Don’t remember. It’s funny, but (public) conversion seems to be more common in Repubs, since Dem politicians have to be loyal to Obamacare and nothing but the Obamacare :rollseyes:

Fredster, that rate increase is nasty. I’ve heard of several states where good ole Big Insurance is planning double digit increases. Sure they’ll be reimbursed by the feds, but this way it’s free money! Riiiight?

quixote@13: Oh I just saw this from you! Yeah it’s nasty and in no way is it needed. Now, BCBS-LA is *not* increasing premiums on plans that are mainly set in nola, baton rouge and shreveport but they have very limited networks for just those areas. So they are, in effect, restricting the networks. That’s not a good idea in a state where some of us on the southern end may have a need to evacuate for a hurricane. Would the ins. be any good if you were out of the network for that reason? Who knows?

@DYB: Oh I wish I’d seen that on Maher. Would have been too funny.

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