The notion that the swirl around the Affordable Care Act is simply enthusiastic chaos coming into gradual order continues to be disproved by stubborn facts. "The Apothecary," his health-care blog for Forbes magazine, Avik Roy has distilled some of the more sobering details.
Among them: The vast majority of Americans signing up for Obamacare through the various exchanges are not the targeted uninsured — those beleaguered souls who were supposed to benefit from exploding the old insurance system — but instead are those who were covered to begin with.
Between 65 and 89 percent of enrollees, depending on the survey, were previously insured. The reasons these formerly insured came to the exchanges are becoming depressingly familiar: old plans became illegal and were canceled; employers dropped coverage; or have seen their plans absorbed and now are paying substantially more (about a 41 percent premium hike) than just last year.
Joan Budden, chief marketing officer at Priority Health, told Wilde and Mathews that Michigan's health insurers had expected 400,000 uninsured Michiganders to enroll in exchange based plans during the initial enrollment year. According to the latest data from the Obama administration, as of December 28, only 75,511 had “selected a marketplace plan.” Of those, only an unknown fraction had paid their first month's premium, and therefore were actually enrolled in new health coverage.
“I don't know if we're growing the number of people with insurance,” a Minnesota-based health insurer told Wilde and Mathews. “We're just adding complexity.”
Roy also notes a study by Sean Trende of RealClearPolitics that shows the Obama administration has wildly inflated the number of new Medicaid beneficiaries due to Obamacare. Glenn Kessler, "The Fact Checker"; at the Washington Post, roasts the boast with three Pinocchios.
All of which (and more) is leading Roy to reassess his previous pessimism about repealing Obamacare.
But what if the number is far less than 34 million? What if it's only 5 million? Such an epic fail would seem far-fetched, but then again, so did the dismal performance of Obamacare to date. For 2014, the CBO has projected that 14 million previously uninsured Americans would gain coverage under the law. With about ten weeks left in this year's enrollment period, we're looking at a coverage expansion of less than a million.
Remember also that as many as 100 million previously insured Americans will endure higher premiums—and higher taxes—under Obamacare. The political constituency of the newly insured could be dwarfed by the political constituency of those harmed by the law. If that turns out to be the case, President Obama's signature legislation may not be long for this world.
Sigh. All that acknowledged, The Right Stuff will need more persuading that such an eventuality is possible, let alone probable.