Obamacare Schadenfreude 05/13/14

Another warm day here in Slower Maryland, with clouds, and the threat of rain later.  A lot like the implementation of Obamacare...

Three-fourths of ObamaCare enrollees were previously insured:

Or so says a new McKinsey survey of the numbers:

One of the principal flaws in the coverage of Obamacare’s exchange enrollment numbers to date has been that the press has not made distinctions between those who have “signed up” for Obamacare-based plans, and those who have actually paid for those plans and thereby achieved enrollment in health insurance. A new survey from McKinsey indicates that a large majority of people signing up are now paying for their coverage. This is progress for the health law. But the survey still indicates that three-fourths of enrollees were previously insured.

Of course we’ve seen the propaganda push from the White House that has claimed the numbers (8 million enrolled) mean that the law is working. As usual, the devil is in the details. If the law was designed to provide coverage to those who were uninsured, 25% of the total enrolled fitting that description is hardly indicative of that claim’s efficacy. And when you break down that 25% number, it’s even less indicative:

So all this fuss and furor was over, what, 2 million people at most?

Really, though, the story of the week is the fading of Obamacare as a new story.  I think it's mostly natural response to the fact that the big enrollment push is over, and the numbers of how many really enrolled, what the demographics are, and what the health and healthcare consequences are haven't really become apparent yet. Two stories on that; one from the right, the other from the left:

Notice Not Obamacare

President Obama has already been forced to admit that his keep-your-plan promises were overstated. The future will bring more changes and cancellations to existing plans. Doctor networks will almost certainly narrow, for example, because shrinking those networks is one of the few ways the law allows insurers to compete on price. Cuts in Medicare Advantage, a relatively market-oriented portion of the program with high rates of customer satisfaction, have been deferred but may eventually take effect.

A law can do some good, of course, while not living up to the promises made about it. It cannot be denied that the law has made some people better off. The coverage expansion means that more Americans have the extra measure of financial security that comes from knowing that medical expenses will not drive them into poverty. That’s a real good, something the law’s critics have sometimes failed to acknowledge.

But Obamacare’s champions have greatly exaggerated what this good involves, and so what it should mean for our overall assessment of the law. During the battle to enact Obamacare, and subsequently, supporters have claimed that the expansion would save thousands of lives. A study of Oregon Medicaid recipients — the best such study we have — has instead found that coverage did not significantly improve any physical health outcomes. If the value of insurance is that it protects against financial calamity, then the approach of Obamacare is radically misconceived: We ought instead to have undertaken reforms to enable everyone to purchase catastrophic coverage. In other words, different policies could have achieved the good that Obamacare has done, at much lower cost. Or perhaps even more good, since the expansion has included fewer people than expected.

Democrats claim victory as GOP goes quiet on ObamaCare

House Republicans have no scheduled votes or hearings on ObamaCare, signaling a shift in the party’s strategy as the White House rides a wave of good news on the law.

Not a single House committee has announced plans to attack the healthcare law in the coming weeks, and only one panel of jurisdiction commented to The Hill despite repeated inquiries. GOP campaign committees also declined to say whether they will launch any new efforts on the law.

The lack of action highlights the GOP’s struggle to adjust its message now that enrollment in the exchanges beat projections and the uninsured rate is going down. Insurers also report that 80 to 90 percent of new policyholders are paying their premiums, contradicting a frequent criticism from the GOP.

This dynamic was laid bare last week as Republicans failed to land punches against the healthcare law in a hearing of a House Energy and Commerce subcommittee. In a rare display, Democrats began to control the message as witnesses from health insurance companies rebuffed several lines of GOP questioning.

Republicans are conscious of the need to keep a drumbeat going against the law.The National Republican Senatorial Committee released a memo on Friday that said the law remained deeply unpopular and that “liberal media elites” touting the idea it was a success were beginning to influence beat reporters desperate for a new story.

Frankly, what I think you're seeing is "Obamacare Schadenfreude fatigue."  You can only complain about the same 50 bad things that Obamacare is going to do to the country and not sound whiny (I'll take the risk). But, at some point, if you can't repeal it or fix it (and the democrats won't let that happen) you just have to step back and point out when your predictions become reality, and hold the democrats accountable.

In Polling Obamacare, A Label Makes A Big Difference

In Kentucky, a new Marist poll conducted for NBC News finds that 57 percent of registered voters have an unfavorable view of “Obamacare,” the shorthand commonly used to label the 2010 Affordable Care Act. That’s compared with only 33 percent who give it a thumbs up – hardly surprising in a state where the president’s approval rating hovers just above 30 percent.

By comparison, when Kentucky voters were asked to give their impression of "kynect," the state exchange created as a result of the health care law, the picture was quite different.

A plurality – 29 percent – said they have a favorable impression of kynect, compared to 22 percent who said they view the system unfavorably. Twenty-seven percent said they hadn't heard of kynect, and an additional 21 percent said they were unsure.

I think this is fully understandable. We are a federal nation. We expect many of the good things that government does to be done at the state level, and we're deeply suspicious (rightly so) of mandates pushed down by the feds.  People in Kentucky answering this survey are being asked two separate things; satisfaction with Obamacare as a federal program and satisfaction with the Kentucky implementation of that program.  It's consistent to be unhappy with the first and satisfied with the second.

The States Where Obamacare Could Still Go Badly

Predicting premium increases is an inexact science to say the least, but health care experts see a troubling number of red flags in certain states. Perhaps the most vulnerable is West Virginia—the home state of Sylvia Mathews Burwell, who's awaiting confirmation as the next Health and Human Services secretary.

"West Virginia sticks out as really worrisome," said Caroline Pearson, vice president at the consulting firm Avalere Health. "Their exchange is not having great luck."

Premiums will go up, on average, across the board—premiums go up every year. But a range of factors could drive higher-than-average increases in certain places. States that fell short of their overall enrollment goals, and where the people who did enroll are mostly older and sicker, are more at risk for large premium hikes. So are states that don't have much competition among insurers.

"If you lose on all of those, then you're really looking bad," Pearson said. And West Virginia lost on all three fronts this year. It only got about 60 percent of the way to its total enrollment target, Pearson said. And it has the worst mix of young adults in the country—just 19 percent of people who picked a plan through the state's exchange were young adults, who are presumed to be healthier and thus help keep premiums in check.

Completing the trifecta, there's only one insurance carrier—Blue Cross Blue Shield—in West Virginia's exchange.
. . .
"Hawaii looks problematic. They could have viability problems," said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation.
. .
Ohio and Arizona, both of which allowed plan extensions, are on Levitt's list of states to watch for big premium hikes. He and Pearson mentioned Iowa, which allowed a two-year extension for canceled plans and was the second-worst state at enrolling its eligible population.

Health care analysts are also keeping an eye on premiums in Maryland, Mississippi, New Mexico, and South Dakota, where officials had to beg and plead just to get one carrier into the state's private market.

Reason's Nick Gillespie, on how to reform Obamacare, if you must:

With More Competition and Choice, Obamacare Might Not Be So Horrible: Yes, it’s a dumb and deeply offensive law to begin with, but that doesn’t mean it can’t be made less dumb and offensive.

. . .OK then. Even though I think Obamacare is a truly epic mistake (more on that later), here are three obvious ways to make the president’s signature legislative achievement better, cheaper, and more cost-effective.

1. Allow anyone who wants to, regardless of income or age, to purchase a low-cost “catastrophic plan.”
. . .
2. Force insurers to compete across state lines. For all the press surrounding the total number of signups, the fact is that each state comprises a solitary health-care market. That means two things, neither of which is likely to make Obamacare more successful or less costly.
. . .
3. Grow the supply of medical care already. Proponents of Obamacare have paid a lot of attention to forcing more people into the health-care system via the individual mandate, Medicaid expansion, and premium subsidies. They’ve spent next to no energy on growing the supply of medical care. It’s not a pretty picture when demand increases and supply stays flat. In fluid markets, you get price hikes; in massively regulated ones such as health care, you get long waiting times, rationing, and pissed-off customers. No wonder nurses and other practitioners are freaking out. . .