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Untangling the Obamacare hype.

June 26, 2017

Lofty headline, isn’t it? If only doing it was as easy as writing it.

Admittedly, nothing real could be nearly as exciting (crazy?) as Elizabeth Warren hollering her head off about blood money and dead Americans, but the facts are interesting too. Not easy to ferret out, but interesting.

So what’s behind all the hate speech and the almost panic-stricken sound bites?

One vitally important thing to keep in mind is that Obamacare was designed to fail.  It was only supposed to be a pathway, an on-ramp if you will,  to single-payer, government controlled, European-style socialist healthcare.

This admission was made by the chief Obamacare architect, Dr. Ezekiel Emanuel, back in March of this year. Once you understand that, then you can look objectively at the hysterical rhetoric.

Hillary Clinton was supposed to make sure that happened.

When the wheel fell off that strategy, it triggered a mass panic attack on the left.

Incidentally, if you want to read the draft version of the Senate’s health insurance bill, you can access it here.

Separating fact from fiction.

The other thing to note is that at least 8 million people still do not have insurance of any kind, primarily because they can’t afford it. These are people willing to pay the penalties instead of being forced onto the government-chosen insurance plans that actually do not cover at least the first $5,000 to $12,000 in expenditures, and that can cost an equal amount or more in premiums.

Without further ado, let’s look at the claim that at least 25 to 30 million Americans are going to die without total government control of healthcare.

First of all, it’s tough to find unbiased reporting. For the purposes of this post, the Kaiser Family Foundation reports were used for illustrations.  Second, some of the numbers reported make assumptions or try to extrapolate missing numbers from such data as does exist. Third, some of the statistical information presented in interactive maps is obscured by the graphics. For the raw data, click on the links below each map.

For instance, the much reported claim that the “vast majority” of ACA enrollees are receiving benefits under Medicaid programs, a claim attributed to Rand Paul, but widely taken as fact by many.

Marketplace enrollment (non-Medicaid, non-employer) is reported as 12.7 million people in 2017, with the rest of the Obamacare population covered largely through expanded Medicaid.

Politifact says they did the research, but their figures are only through the end of 2014.  Their conclusion is that Paul’s quote is “half-true”.  They verify that more than half (53%) of the newly covered people lumped in under the total Obamacare enrollment numbers do get their insurance benefits solely through expanded Medicaid, but not the “vast” majority.

Some of the people enrolled in Medicaid since Obamacare’s passage would have been eligible under original Medicaid income limits anyway.

Apples and Oranges

Speaking of Medicaid and SCHIP income eligibility limits, usually expressed as a percentage at or above the Federal poverty level, it is a fallacy that this is a single rate.  Each state is allowed to use their own income limit calculations, as noted in this KFF report.

For the majority of states, the limit is 200% of the Federal poverty level for SCHIP eligibility, and 138% for single adults to qualify for Medicaid..

Another fallacy is that income qualifiers for premium subsidies under the ACA are the same as they are for Medicaid and SCHIP eligibility. Premium subsidy income eligibility guidelines are much more generous than they are for the government programs, by almost double.

When you figure in Obamacare, the picture gets even murkier, as noted in this paragraph from the first KFF link above : (Underlining added.)

In 12 of the states with a State-based Marketplace (SBM), there is one system that determines eligibility for Medicaid and Marketplace coverage. The remaining 39 states transfer data back and forth with the Federally-Facilitated Marketplace (FFM), HealthCare.gov, to coordinate eligibility decisions.”

What changes the mathematically eligible enrollment figure is the ACA poverty level limit. Those limits as of January 2017, as reported by The Department of Health and Human Services are $12,060 for a single adult, $20,420 for a family of three,  and $24,600 for a family of four.

In contrast, the HHS limit for single persons in 2008 was reported at $10,400 and for a family of four, $21,200 for Medcaid..

In should be noted that these figures are reached AFTER application of modifying factors such as the consumer price index. Thus they may differ substantially from raw income figures.

More current figures (through March,  2016) are presented by these graphic maps from the Kaiser Family Foundation (KFF), but they acknowledge that even their figures involve some guesswork, and the maps do not include actual enrollment numbers and breakdowns for their “by-state” reporting. For that you need to click on the link below each map to view the raw data.

They are at least useful for determining which states did not offer expanded Medicaid.

Eighteen states were sufficiently suspicious of the longevity and reliability of Federal help to decide not to offer expanded eligibility. Thirty-one states do offer expanded Medicaid eligibility. North Dakota is not included, since it doesn’t report data to CMS, nor is the District of Columbia, because it is not a state.

Using the KFF data in this model, we can see that in the 31 expansion states, total Medicaid enrollees number 73,421,500.  Of that figure, 14,409,600 are enrolled through expanded Medicaid, while 3,266,900 new enrollees were eligible under the “old” rules.

Going to the problem with syncing up the data, another KFF spreadsheet shows the 50-state April 2017 total Medicaid and CHIP enrollment for the nation as 74,531,002, a 29% growth rate since the ACA went into effect.

Regardless of the million or so difference, when Dems say that under any new plan as currently presented, “everyone” will lose their Medicaid coverage and die, they are cherry picking and massaging the facts. None of the 18 non-expansion states should be affected by the change. At worst, that’s just under 14.5 million, and acute emergency care is still required to be covered for anyone. In addition anyone who would have qualified under the pre-expansion guidelines keeps or is eligible for coverage.

To  be sure, 14.5 million is a lot of people. Still, it’s just 19.4% of everyone on Medicaid.

That’s hardly “everyone.”

It also doesn’t take into account the money the Federal government will pass back to the states (after taking out  their average 10% handling fee on taxes collected, of course.) Instead it just assumes states will not change their individual requirements to cover some of the expansion enrollees.

Neither do Dems note that as people are able to find work, they would drop off the rolls anyway, possibly to be covered by employer plans, or able to now purchase coverage on their own.

On the GOP side, it’s not widely advertised, but most states are going to have to start collecting a new tax or maybe two or three taxes to pay for what the Feds will no longer fund if demand for Medicaid coverage exceeds funding.

Some states, like California and New York won’t have a problem with that.  It fits right into their world view of government confiscation and redistribution of funds. Besides a payroll tax, it’s likely that most of those new taxes are going to target the 1%, probably with some sort of  state income tax surcharge and increased so-called luxury and “sin” taxes.  Some taxes could also hit things like gasoline and fossil fuel created energy, which we all use or benefit from.

Other states, particularly those in the bottom third for per capita income, will not be able to soak much more out of the people than they do already, and under the new plan they won’t have the benefit of using only FICA tax money from other states to smooth out the funding problems.

That’s where the cheese will get binding. Those are the states that may well find people’s access to care seriously impacted.

Further, there is no guarantee that the Feds won’t simply quit funding Medicaid in any form, reserving the money instead for Medicare, and turning both the people and the financing over to the states at some time in the future.

The only thing all of this noise does prove is that once you create a government program, it isn’t EVER going away. Sorry, Senator Paul, but Obamacare, or at least the premise behind it,  is another “forever” entitlement program and at least in some form it will probably stay.

Also important to remember is even after the complete destruction of the private healthcare insurance market as we knew it, as envisioned by Dr. Emanuel, “pure” Obamacare still only covers 3.9% of the entire population of the United States, not 30%. Even adding in those with expanded Medicaid benefits, Obamacare (non-employer) marketplaces only cover 8.4% of all of us.

Of course that’s going to fail financially. That’s why the coercive and punitive penalties, along with medical device taxes, were imposed on employer and individual plans, and people are required to carry coverage (essential benefits) that has no value for them.

Unintended consequences.

The people who are actually going to have to live under whatever finally happens note with increasing disgust that the discussion is all about the “political fallout” if this does or doesn’t pass.

That disgust with both parties is starting to take on a far more strident tone, with calls for strict and short term limits beginning to rise to the surface again.  There have been several organizations[1] working since the early 1990’s for meaningful Article Five voting to take place.  There are also grassroots calls for these groups to get together in a nonpartisan, national joint campaign to put teeth into the movement.

Incidentally, that movement will merit a post of its own in the future.

One man pretty much spoke for an increasing number of Americans when he said:

“Look. I’m fed up to my eyeballs with this country only being run for the politicians and their mouthpieces, the media. I don’t give a f— whether any of them get re-elected. It’s time to change this “Washington first, last and always” mentality.  Doing it at the polls by changing presidential parties obviously didn’t work. I’m getting older, but by God, I am ready to do something to clean up government, and if that means a human wall blocking the polls so nobody gets elected until we get an Article 5 term limit law passed, I’ll volunteer. We have to do something constructive, before you have lots of people shooting at each other, not just one crazy guy in Virginia.

It’s a damned crime that anyone is in power for 30 or 40 years, from either party. I went to war outside the country to defend it, and I would sure as hell work hard to defend it within the borders if that’s what it takes. Just show me where to sign up!”

Chilling out

Was all this histrionic political hyperbole and uncounted hours of legislative time-wasting over the last decade worth it?  It’s hard to see how, if the net sum is the end of the U.S. as we have known it.

Of course, until we see a reconciled, finished bill that has passed both houses of Congress,  all of this is supposition, a giant game of “what if”  anyway.

Under the Senate draft bill, the changes would not take effect until at least 2021, giving states and insurers at least four years to adjust if the final bill becomes law this year.

Still, even this very abbreviated explanation (well, as abbreviated as it can be, given the complexity of the subject) should convince you to tune out all the claptrap and put the hype on “ignore” for the time being.

Go play with your kids, have a beer, go fishing, or do whatever else you do to unwind, and tune back in later, when there is actually something real to discuss.

[1] http://www.wtamu.edu/~jrausch/tlgroup.htm (list of groups);  Caution: NOT an all-inclusive list, and it may be out of date.

 

From → op-ed

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