Obamacare Enrollment Hits 7 Million, Putting Downward Pressure on 2015 Premiums; Word-of-Mouth Spreads the Truth
Maggie Mahar at The Health Beat Blog has been keeping track of the progress made by people in enrolling in the PPACA. Cross posted from The Health Beat Blog.
As the “train wreck” called Obamacare pulls into the station it’s becoming clear that some 7 million Americans are signing up to purchase insurance in the Exchanges. Ten days ago I went out on a limb and predicted that we would hit 7 million, if not by March 31, by early summer. Now it appears that we’ll break through that target by midnight.
Seven million was the Congressional Budget Office’s (CBO’s) initial estimate, but when the roll-out proved rocky, the administration lowered its expectations to 6 million. Reform’s opponents groused that this still was too optimistic, and before long the consensus estimate fell to 4 to 5 million. (Conservatives, who had helped lower the consensus, then accused Democrats of moving the goal-post to make it easier to claim success.)
Younger Americans Join the Pool
Who are these last-minute shoppers? According to the Wall Street Journal,carriers are beginning to report that many are under 40. Today, more insurers confirmed the trend. This should come as no surprise.
We always knew that people in their 50s and 60s would join the Exchanges first. Healthy 20-somethings and 30-somethings who rarely see a doctor would be in no rush to sign up. Why begin paying premiums before you have to?
Momentum Builds
Now, younger Americans are jumping into the pool, and, most importantly, the pace of enrollments is building. Friday, March 28, Charles Gaba, the “numbers Geek” who has correctly predicted earlier enrollment milestones, wrote: “We’re in uncharted territory. . . Things are moving VERY quickly now, and events are quickly overtaking my ability to keep up.” Yesterday (Saturday, March 29), Gaba hiked his March 31 estimate to 6.7 million, up from 6.22 million earlier in the week.
Keep in mind that, in most states, anyone who gets on line before the March 31 deadline, begins an application, and experiences technological difficulties, can complete that application in April. By the time those late entries are tallied,enrollments will top 7 million. How high will they go? All bets are off.
Some in the Media Downplay the News
Inevitably, enterprising journalists are trying to distinguish themselves from their colleagues by finding a new angle on the story: “National Enrollment Looks OK, But States Matter More,” NPR’s Julie Rovner declared.
Newsweek’s Zach Schonfeld was downright snarky::“Obamacare Reaches Its Target. Can We Stop Pretending That Number Matters Now?” According to Schonfeld, whether 6 million or 7 million people sign up, this is a “minor victory for the president.”
What Schonfeld fails to understand is that what matters is not the number of people who have enrolled in a particular state, but the momentum. The sudden surge suggests that as the number of people who have bought insurance reaches a critical tipping point, the public’s view of Obamacare is changing.
Indeed, a recent Kaiser Foundation study reveals that the public is warming to reform. Over the past two months the share of respondents who supported the ACA rose from 34% to 38%. Tellingly, since February, opposition among the uninsured has dropped 11%, while support had increased by 15%.
A significant majority oppose repealing Obamacare. Fifty-nine percent of those surveyed said they wanted Congress to either “keep the law in place and work to improve it,” or simply “leave the law as is.”
What is happening? Over the past two months, as more Americans bought coverage, they began talking to friends and relatives who, until now, didn’t know who or what to believe about the Affordable Care Act (ACA). Now those friends are learning about premiums and generous government subsidies from people they know and trust. At last, the fog of disinformation is lifting, and the reality of Obamacare is sinking in.
By early summer, we’ll see the effect even in states where enrollments have lagged. Just in the past two days, sign-ups in Red States have surged. Who knows? Maybe the mainstream media will replace anecdotes about “Obamcare’s victims,” with the facts that people need to know..
Today Kaiser’s polling shows that about one-third of the uninsured are not aware that the law includes subsidies that could help them buy insurance. Forty percent to 50% don’t know about the most popular provisions of the law: the guarantee that people cannot be denied coverage–or charged more– because of pre-existing conditions; the expansion of Medicaid ;and the rule eliminating out-of-pocket costs for preventive care.
Perhaps our newspapers and networks will begin tospread the word that, thanks to government subsidies, millions of people who will be able to buy a “zero-premium policy.”
Who Knew That Insurance Could Be Free?
That’s right. What most people don’t know—and what Fox News hasn’t been telling them–is that that roughly 6.5 million Americans will be able to purchase insurance without paying a penny. The insurance will cost them nothing because the tax credit that they receive from the government will cover the entire cost of a bronze plan.
Who will qualify? In the fall Credit Suisse published a table revealing that, in many states:
- an individual earning somewhere between $11,490 and $20,100;
- a family of three with joint income under $34,170;
- and a family of four earning less than $41,200
will be able to find a $0 premium bronze policy.
McKinsey & Co, a leading global management consulting firm, agrees, and estimates that roughly half of those 6.5 million will be under 39.
Even if a family’s household income is somewhat higher, many will discover that, after applying the government subsidy, health insurance may well cost significantly less than their monthly cable bill.
Based on that analysis, back in September, Credit Suisse’s Ralph Giacobbe predicted that “affordability may not be a roadblock” to achieving the CBO projection that 7 million people will buy insurance in the exchanges in 2014. “Simply put,” he wrote, “we don’t see any logical reason why anyone in this population wouldn’t take free healthcare coverage vs. remaining uninsured.”
But, Giacobbe added, much will depend on “education, outreach and logistics /IT.”
As we all know logistics/IT didn’t work out very well—though as time passes, that matters less and less. (Granted, even today, there were computer glitches, but they were fixed quickly) And it’s clear that his month’s outreach effort worked. Going forward I believe that word-of-mouth will continue to drive “education.”
A “Tipping Point”
Many of us who had read the law knew that once people experienced Obamacare, they would like it. Now I think we have reached that threshold where “an idea, trend, or social behavior crosses a threshold, ‘tips’, and spreads like wildfire.” Just enough people have signed up, and are happy with the policies that they have found, that others are learning the truth about the Affordable Care Act.
In the months ahead it will become harder and harder for reform’s opponents to confuse the public with half-truths and outright lies. People will say, “But that’s not what happened to my brother, or my neighbor next door.”
Desperate Deniers
Little wonder, reform’s opponents are getting desperate. In a last-ditch effort to deny reality, they are claiming that we can’t count someone as enrolled unless they have paid their first month’s premium.
But as Gaba explains, “the percentage of enrollees who haven’t paid that initial premium “is a rolling average. People who enrolled between 2/16 and 3/15 don’t even start coverage until April 1st, while anyone who enrolls between 3/16 – 3/31 won’t start coverage until May 1st.
“In many cases, their first month’s premium won’t even be due until up to 6 weeks or more after they enroll. . . it’s silly to write these people off as deadbeats. The vast majority of these will eventually be paid up; it’s just that we won’t have confirmation of many of them until well into May.”
After all, how many people do you know who pay their bills before they get them? How many pay two or three weeks before they are due?
2015 Premiums
Finally, as enrollments soar, what will this mean for Exchange premiums in 2015? Will they really “sky-rocket” as so many for-profit insurers want us to believe?
No. Climbing enrollments will mean larger, more diverse pools which, in turn, will attract more carriers vying for market share. Because of the way the Exchanges are designed, they will have to compete on price.
But that’s my next post.
– See more at: http://www.healthbeatblog.com/2014/03/obamacare-enrollment-heads-for-7-million-putting-downward-pressure-on-2015-premiums-word-of-mouth-spreads-the-truth/#comments Maggie Mahar, The Health Beat Blog
In 2009 the mantra from the Right, and supposedly one that would put ‘Paid’ to PPACA, was ‘Read the Bill!’
Well some of us did. And it wasn’t hard really, because that 2000 pages was double spaced, in large print and with large margins (to allow for old fashioned ‘marking up’ with a pen) and included huge chunks of existing law only to cite it as “to be replaced” followed by the new stuff. Lets just say that reading through the various versions as produced by the House Tri-Committee and then Senate HELP and then the compromised versions that were the Speaker’s and Leader’s Marks just wasn’t that difficult a task. Those 2000 pages reduced to about maybe 50 pages of pure text that had to be mastered to understand how this would play out. Ultimately.
And so it proved. Maggie ‘Read the Bill’, Run/Bill ‘Read the Bill’, even Your Humble Correspondant ‘Read the Bill’ and guess what? There were no Death Panels and the affordability components were pretty well designed to make the end product ‘affordable’. Hence mayb ethe shorthand title ‘The Affordable Care Act’. If you Read the Bill.
Which gets me to another point. Of course ACA was designed to cover the uninsured. But that ‘Affordable’ piece was also designed to cover the underinsured, people who were paying for junk insurance or those who were paying too much for insurance that actually met their needs. The push by the media to just focus on the totally uninsured and to discount the millions of people who know have better insurance at a lower cost, or even those people who have better insurance at a HIGHER cost, is just to ignore the fact that millions of people who were ‘covered’ had more of a fig-leaf or at best a worst case catastrophic care policy than something your typical enrollee in a major employer health care plan took for granted.
And all that was baked right into the legislative language. For example the range of mandated services that also came without cost sharing at all covered almost all routine care for children. Not just obvious preventive stuff like vaccinations but a whole range of ‘well baby care’. Under ACA there would not be a tradeoff between diapers and formula on the one hand and your three month and six month (or whatever) recommended baby visits to the pediatrician.
And those of us who were trying to counter the cries by scaremongers of “Read the Bill!” with the assertion “Well I did and it doesn’t have anything like what you claim it does” were often left frustrated. But some of us in the back of our minds said “Fuck it, no matter what they say a lot of this will come out in the wash once this thing phases in”
Because we “Read the Bill”. And after the Supreme Court ruled on the Constitutionality no matter of IT screwups was going to de-rail this particular train once it gained steam. Leaving the would be saboteurs left sputtering “Cooked the Books!”
AP confirmed the 7 million also. “AP sources: Health law sign-ups on track to hit 7M” http://news.msn.com/us/ap-sources-health-law-sign-ups-on-track-to-hit-7m
Wow, such euphoria.
This is the end of the first inning of a double header. Declarations of victory are a little premature.
Insurance may be “free” but services are not. There are dozens of pieces of the provider and insurance puzzle yet to play out. Not to mention the patch work financing or the inability of DHHS_CMS to do anything in a timely or competent manner.
I should not complain though, I have projects scheduled through 2015 and the mess is just beginning.
Have fun boys.
STR:
One small step at a time. You could always vote with the Republicans another ~50 times and go back to what? More of the insurance and healthcare industry doing nothing to resolve the issue of the uninsured. You always claim you know more; but, you have yet to use that knowledge of your to educate us.
“Many of us who had read the law knew that once people experienced Obamacare, they would like it.”
Yea, I mean for those who really experience it meaning use the insurance which is eventually a lot of people. But initially the high-deductible many-zero-out-of -pocket-services model can look pretty bad because people notice the deductible, but don’t notice the more complicated zero-out-of-pocket part. Also I think some of the uninsured have been uninsured for a while, or were some time ago insured under some really good plan of their parents or something and unfairly blame Obamacare for the pre-existing insanity of private insurance.
So it may be a slow trickle of popularity, rather than a sudden rush.
Jeff:
You do have the obligation to ask questions and read.
save_the_rustbelt
April 1, 2014 9:46 am
Wow, such euphoria.
This is the end of the first inning of a double header. Declarations of victory are a little premature.”
I would pay more attention to this if the “declarations of disaster” you have predicted for the last several years were given the same treatment.
So if the ACA is such as success why are red state Democrats running from it as fast as they can? Why have there been so many delays and exceptions? Also why is public opinion of the ACA so dismal? Are you predicting premium decreases in 2015?
1. It is Obamacare
2. It is a complicated piece of legislation
3. People are stupid and half the country hates Obama with a passion.
4. Not my question to answer.
Oh, and it will never really be all that popular. Probably popular enough to survive, but whats the end user experience? The confusing, arbitrary, and downright nightmarishly bureaucratic US private health insurance system. Nobody is going to be ‘happy’ with it.
Supposition
Jeff,
I disagree.
Nothing is more nightmarish than no coverage, and very few things are worse than underinsurance.
You disagree?
You think people will be happy with it? People will go to other countries and say “you ought to replicate our health insurance system, because its the bees knees!”?
You think our private health insurance bureaucracy is not nightmarish? Seriously? I mean people literally have nightmares about it.
EMichael, what good is insurance when you can’t find a decent doctor willing to work for almost nothing?
I have HMO and PPO dental insurance. My HMO dentist told me he couldn’t save a tooth. I went to my PPO dentist and he saved it.
Sure, you can buy insurance cheaper, but what do you get for it?
And, I wonder how many of those six or seven million Obamacare sign-ups for 2014 have major health problems, including younger sign-ups.
Jeff,
I think people who had no insurance are going to be happy to have insurance. I think people with comprehensive insurance are going to be happy they do not have bare bones coverage. I am certainly not defending the US healthcare system, what I am defending is the US healthcare system is better now than before the ACA.
Most people’s problems with the ACA(other than the black man thing) is that it doesn’t correct all of the problems in our healthcare system. And somehow people think that means the ACA caused all of the problems in our healthcare system.
Peak,
I’d rather have hot nails driven into my eyes(even if I was uninsured) than have a discussion with you about the ACA.
EM-One of the major selling points of the ACA was indeed “people who had (have) no insurance are going to be happy to have insurance”. If that was/is the case why have so few uninsured people signed up? If there were 40 million uninsured in 2008 and today 7 million have signed up thru the ACA (who knows how many of those sign ups were previously insured) are you saying that at least 33 million people are “not happy”? Or are they part of the racist/stupid half of the country?
As to your assertion that the delays and exceptions are due to the complicated nature of the ACA I am wondering if you think there should be exceptions and/or delays for the very wealthy to file their tax returns? You can probably understand since the tax code is very complicated.
little john:
You sell insurance albeit not healthcare insurance. I would think you would know the answer to that question already. The Repubs trot it out every time they wish to muck up the water. This is something I posted in the local Weekly Reader for the locals who believe Fox News as you do.
The orifice Mr. Pinta speaks from is more accurate than the orifice between your chin and nose. Setting that aside, lets continue. Next time you write something like this, simple one liners; why not do some quotes? Your statements have little or not basis and are just your opinion.
Ada: Per the CBO, 30 million will still be uninsured when all is said and done.
Me: The state exclusions (SCOTUS) for which many blogs, politicians, and conservative think tanks such as Cato blame the PPACA as causing are the result of states not expanding Medicaid and accounts for 15.1 million uninsured of the potential 31 million. Another estimated 11.2 million are considered to be illegal residents of the US who will not be covered by the PPACA. Treatment of Non-Citizens is not included under the PPACA and consequently they do not have healthcare insurance. The balance of the uninsured is made up of those exempt from being insured, those opting out and paying the penalty, those who may not understand how to apply for Medicaid, etc. http://angrybearblog.strategydemo.com/2013/05/31-million-uninsured-under-the-ppaca.html#sthash.SOokJO9K.dpuf A knowledgeable author at this blog. Furthermore, I would add that those who lost insurance lost their policies mostly as the result of companies cancelling them or changing them which removed the grandfathering clause.
Ada: Premiums and deductibles are NOT affordable if you fail to qualify for Medicaid or subsidies
Me: Sorry, that is innuendo, supposition, and conjecture on your part and has “no” basis. Maybe you can trot out Emile Lamb or Julie Boonstra as examples, please, please, please.
Ada: In June of 2009, Sen. Jim DeMint (R-S.C.) introduced the “Health Care Freedom Plan,” a 41-page proposal.
Me: “The plan, basically, is for the federal government to give out annual vouchers to Americans which they can spend on any health care insurance offering they want: $2000 dollars for individuals, and up to $5000 for families.” http://www.salon.com/2009/06/23/demint_health_care_plan/
Hmmm, the amount offered is ~1.5 months of healthcare subsidized by the Gov using TARP money. When Tarp runs out, what do you do then and there is nothing done to rein in costs. This is not a serious proposal it is a spray- painted graffiti proposal done on the run.
Ada: In May of 2009, Republicans in the House and the Senate formed a bicameral coalition to produce the130-page “Patients Choice Act of 2009.”
Me: ” The plan itself is like the bastard child of the Massachusetts health reforms and the McCain campaign proposal. And that’s not a bad thing. Like the McCain health reforms, it erases the employer tax exclusion. That means the health benefits your employer purchases for you will get taxed. And that means your employer is likelier to drop your coverage. The idea here is simple: To end the favoritism given to employer-based health care. Ezra Klein http://voices.washingtonpost.com/ezra-klein/2009/05/dissecting_the_republican_heal.html
Ada: In July of 2009, the Republican Study Committee, under the leadership of Rep. Tom Price (R-Ga.), unveiled the “Empowering Patients First Act,” a 130-page plan.
Me: ” Price’s bill has a couple of good ideas in it: Automatic enrollment, for one thing. And extending the employer tax deduction to individuals while capping it at “the average value of the national health exclusion for Employer Sponsored Insurance (family/singles) grown at inflation.” This amounts to a huge tax increase, incidentally, although Price won’t call it that.
But the plan won’t work. In particular, its version of the health insurance exchanges will collapse pretty quickly. There’s no individual mandate ensuring that the pool includes both healthy and sick individuals, no insurance market regulations stopping insurers from cherrypicking, and no risk adjustment rebalancing the scales when they do. In other words, this looks much like the reforms that collapsed in Texas, and in California. Price isn’t learning from past policy mistakes, and so he means to repeat them. http://voices.washingtonpost.com/ezra-klein/2009/10/rep_tom_prices_empower_patient.html
Ada: The blatant lie that “You can keep your insurance” and the millions who have lost plans they were content with.
Me: Heh, heh. It always amazing me how Republicans and Tea-baggers can distort what was really said and then expect to walk away unscathed. ” Back in June of 2010, Health and Human Services Secretary Kathleen Sebelius held a press conference to announce that, under Obamacare, millions would be moving to new plans. As I point out in this post, a HHS press release spelled out the numbers: “roughly 42 million people insured through small businesses . . . along with “17 million who are covered in the individual health insurance market.”
and here: Obama first made that pledge in 2008, while debating John McCain. The context is crucial: Obama was addressing “the majority” of Americans (roughly 66% ) who worked for large companies that paid 75% to 80% of their premiums –not the minority who purchased their own insurance in the individual marketplace (5%), nor the 17% who were insured by small business owners.
“So here’s what my plan does. If you have health insurance, then you don’t have to do anything. If you’ve got health insurance through your employer, you can keep your health insurance, keep your choice of doctor, keep your plan.” http://angrybearblog.strategydemo.com/2014/02/why-are-so-many-americans-confused-about-obamacare-how-a-video-produced-by-cbs-washington-bureau-misled-millions-part-1.html#sthash.YsfxPHFN.dpuf You really need to read this guy as he is credible. Any questions as to who said what?
Ada: The cost of the ACA will NOT be revenue neutral as was professed when the law was passed. The CBO has confirmed that.
Me: Of course it “may” not be revenue neutral as originally thought. With 25 Republican states not passing the Medicaid expansion, the costs are now higher . . . duh! Com-on Ada, where do you come-off making these one liners which are so obviously thick headed?
Bruce–
Your detailed comment makes it clear that you have actually read the ACA.
You make an especially good point when you underline the fact that many people who have now signed up in the Exchanges were “underinsured.”
That had a piece of paper called insurance, but it didn’t protect them
The most popular plan in the New Jersey market where people bought their own insurance didn’t cover chemo. Or ambulances. What if you were diagnosed with cancer? No chemo (unless you were very very wealthy and could pay for it out of pocket.
Conservatives are now trying to say that Obamacare isn’t really helping that many people because only a relatively small number were
TOTALLY uninsured before purchasing comprehensive insurance in the Exchanges.
But the fact is that they “coverage” that many of them had in the past didn’t cover.
STR–
You write: “There are dozens of pieces of the provider and insurance puzzle yet to play out. Not to mention the patch work financing ”
Can you name dozens of pieces yet to play out?
Can you describe, in detail how the legislation is financed?
I can–and have in this white paper. http://tcf.org/work/social_insurance/detail/better-care-for-less-how-the-affordable-care-act-pays-for-itself-and-cuts-t/
(The financing is very solid. As the Congressional Budget Office points out, the ACA pays for itself And cuts the deficit.
JEFF–
I agree that the whole country will not lean about the benefits of Obamacare all at once. But I predict the news will ‘trickle down” with some speed. I really do think we have hit a tipping point. Though it will be harder to get the information to the Latino community–both because of language barriers and because this community is wary of
government..
But you’re mistaken on one point.
You write: “But initially the high-deductible many-zero-out-of -pocket-services model can look pretty bad because people notice the deductible, but don’t notice the more complicated zero-out-of-pocket part..
Many newspapers (including the WSJ) have reported that the deductibles are high. THIS IS NOT TRUE. WHEN YOU LOOK AT DEDUCTIBLES FOR ALL EXCHANGE PLANS YOU FIND That only Bronze plan deductibles are higher than deductibles in the market where people bought their own insurance Pre-Obamacare.
And only 19% of Exchange Shoppers have bought bronze plans.
62% picked silver. The rest picked gold or platinum
The average silver deductibles is 48% lower than the average bronze deducible. And the premium for a silver plan is only 8% higher.
4% of all Silver plans
6 % of all gold plans and
41% of all platinum plans come with a ZERO Deductible
These 0-deductible plans have turned out to be very popular.
Finally the typical gold plan comes with a deductible of just $1,276
platinum deductibles average $347–”90% less than the deductible average for the 2013 pre-reform market.”
if you buy silver you are likely to face a $2,905 deductible—far less than the $5,081 bronze deductible the Journal cites–and lower than the average in the pre-Obamacare individual market.
Caps on out of pocket spending are also lower in the Exchange.
For a full discussion of the misinformation about deductibles in the Exchanges see this post http://www.truth-out.org/news/item/22608-why-is-it-that-so-many-reporters-seem-to-know-so-little-about-obamacare
Little John–
You ask: ” why have so few uninsured people signed up? –
If you had read the post, you would know the answer:
ne-third of the uninsured are not aware that the law includes subsidies that could help them buy insurance. Forty percent to 50% don’t know about the most popular provisions of the law: the guarantee that people cannot be denied coverage–or charged more– because of pre-existing conditions; the expansion of Medicaid ;and the rule eliminating out-of-pocket costs for preventive care. ”
The media has done a dismal job of getting the facts to the public.
Too many journalists have been busy spinning anecdotes about ‘
“Obacmacare’s victims.”
As for Red State Democrats running away from the bill– We’ll see.
Some of their political advisers recommend this strategy because so
many Red state voters hate Obama.
But Bill Clinton says its a dumb idea, and recommends running On
Obamacare. When all is said and done Bill is far smarter politicians than 98% of the advisers out there. And, he understands the South.
EMichael–
]
You make a very good point: ‘Most people’s problems with the ACA(other than the black man thing) is that it doesn’t correct all of the problems in our healthcare system. And somehow people think that means the ACA caused all of the problems in our healthcare system.”
Exactly.
This is a big country. The health care system is complicated, and different people have different needs. Going forward we improve the ACA–though I expect little to happen in the next two years, except that more states will expand Medicaid. In D.C. gridlock will make major changes impossible.
But that’s not a terrible thing–two years will give a change to see what is and isn’t working.
I don’t know much about Fox News other than it drives some people crazy. I’ve never watched enough to know why.
In terms of uninsured citizens, thanks for admitting that the ACA will not get everyone covered. So the ACA’s main claim of fixing the uninsured problem is untrue.
I am self-employed so I have to buy my own health insurance. On the exchange, for a silver plan, which is almost identical to what I have now the cost is about $100 more per month than what I currently pay. I cannot understand exactly why. Me, wife and three kids, $880 per month. But, I did get a MLR check this year of $125! Isn’t that great? The ACA hasn’t bent the cost curve for me.
As to the GOP’s plans, who cares? We’re talking about the ACA not Jim DeMinted’s plan!
And for the hundredth time were are not debating what a presidential candidate said during a debate. We’re talking about what a sitting President said about his signature piece of legislation. Again, go to whitehouse.gov and check out the President’s comments after the SCOTUS upheld the individual mandate.
Nonetheless I am glad you are able to get coverage, given your medical issues, thanks to the ACA. I understand why you’re such a huge cheerleader. And I hope the title of this post about downward pressure on 2015 premiums comes true. But if that sentence is anything like the rest of the ACA predictions…I guess I’m in for a large rate hike in October!
Run 75441-
Thanks much for your responses to the comments above!
Maggie-So your argument is that the media is to blame for the lack of enthusiasm for the ACA? You say “we’ll see” about Red state Dems running from the bill? You are aware of the ACA changes proposed by Red state Senators recently right? I think that’s called running.
And, when Bill Clinton runs for office, let me know.
Little John–
You write: “And I hope the title of this post about downward pressure on 2015 premiums comes true. But if that sentence is anything like the rest of the ACA predictions…I guess I’m in for a large rate hike in October –
I don’t know what prediction you are talking about.
In 2009 REpublicans said the ACA would never pass. I said it would. It did.
Then they said Obama would not be re-elected in 2012, and when he left town, they would repeal the ACA–or at least make major changes.
Didn’t happen.
Throughout 2012 and 2013, they continued to try to repeal the ACA–
didn’t happen.
In 2013, they predicted that premiums would be sky-high. Turned out to be 20% lower than CBO projected–even before subsidies.
After subsidies– most Exchange shoppers have found that premiums are significantly lower than they were pre-Obamcare in the individaul
market where people bought their own insurance.
Then the conservatives said, “Well maybe premiums aren’t so high–but wait till you see the out-of-pocket costs! Wrong again.
See my response to Jeff above.
Reform’s opponents kept on lying about the deductibles and said
very few people will sign up in the Exchanges because the doverage is so expensive.
I predicted 7 million–despite the many computer glitches.
As of yesterday, they broke 7 million . And the late applications that were started before March 31 haven’t yet been counted.
What about fewer doctors and hospitals to choose from, longer waiting times, or no new patients. Also:
Doctors Say Obamacare Rule Will Stick Them With Unpaid Bills
March 19, 2014
NPR
“Doctors worry they won’t get paid by some patients because of an unusual 90-day grace period for government-subsidized health plans.
So several professional groups for doctors are urging their members to check patients’ insurance status before every visit.
Consumer advocates say these checks could lead to treatment delays or denials for some patients.”
http://www.npr.org/blogs/health/2014/03/19/291413910/doctors-say-obamacare-rule-will-stick-them-with-unpaid-bills
“Doctors worry . . . ”
Nothing new there. But *how many* doctors? And are their worries justified?
” . . . these checks could lead . . . ”
On the other hand, maybe they won’t. There were plenty who predicted an ACA train wreck. So far, the egg seems to be on their faces.
NPR does a good job of pimping the conservative critics of the ACA, PT. And you do a good job of cherry-picking the negative prophecies.
Joel, we can’t ignore supply and demand. What if someone buys health insurance and wants to use it, and then discovers, with millions of new users, doctors aren’t accepting new patients or there’s a long waiting list? They wouldn’t be too happy, would they? Particularly, since they fell behind on their bills, or stopped going to the Sizzler and Starbucks, because they were forced to buy health care insurance. And, they can’t find another job to pay the deductable anyway without next year’s the tax credit 🙂
“What if someone buys health insurance and wants to use it, and then discovers, with millions of new users, doctors aren’t accepting new patients or there’s a long waiting list?”
That happened under the old system, too. What happens is that other docs take up the slack. Medical schools all over the country have increased class sizes in the last five years, and new schools are opening to train even more docs.
I’m not too worried, since Obamacare, nee Romneycare, has been working in MA for years. I’m much happier that uninsured people now can get insurance, that nobody can be denied insurance because of a pre-existing conditions, that nobody need be bankrupted by healthcare costs and nobody will carry health “insurance” that is “affordable” only because the deductibles are so absurdly high that they aren’t really insured for most purposes. Will some people not be too happy? Sure. Some people are always unhappy. But things are way better for millions of Americans. I’m glad of that.
Joel, getting health care insurance is not the same as getting health care, and you can’t go bankrupt waiting for health care. However, I agree, there will be winners and losers.
It seems, Obamacare will increase shortages of MDs:
http://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.html?ref=health
PT:
No it will not create a bigger shortage of doctors. The PPACA will lessen the shortage of doctors in several different ways.
“First, Obamacare puts a new emphasis on team work, with nurse practitioners (NPs) and physician assistants (PAs) becoming part of the team. We don’t need to train more MDs, say some doctors, we need to make physicians more productive by using NPs and PAs as “physician extenders”. NPs and PAs are health professionals with graduate degrees, who are authorized to examine, diagnose and treat patients. When they work alongside doctors, they can free MDs to spend more time with complicated and difficult-to-diagnose cases.
Because the ACA has provided new funding, their numbers are growing. The American Academy of Physician Assistants expects 10,000 new PAs by 2020. Meanwhile, nursing schools have received stipends designed to train 600 new nurse practitioners and midwives by next year.
According to a recent study, the ACA can cut the physician shortage in half by doing just two things. First, expanding nurse-managed Community Health Centers that serve low-income patients who now often receive their care in ERs. Second, reward medical homes where physicians, NPs, PAs, pharmacists, and nutritionists use electronic medical records to coordinate care. Typically they will use e-mails and telemedicine to stay in close touch with patients. If they succeed in managing chronic diseases – and keeping patients out of hospitals – they will receive bonuses. http://www.theguardian.com/commentisfree/2014/jan/28/obamacare-doctor-shortage-myth “Obamacare isn’t creating a doctor shortage, it’s solving it. It’s a myth that America doesn’t have enough doctors. The key to the future of US medicine is to utilize more nurse practitioners.”
I have told you this before PT, nest your posts.
What worries me is the CBO says Obamacare will lose the equivalent of 2 million jobs, e.g. through working fewer hours, more health care will be consumed, and fewer other goods consumed (which will skew GDP towards health care consumption), while more time is wasted filling out forms and waiting in line.
I think, a competitive market with much less regulation would lower health care prices and raise real GDP. So, consumers receive more health care and the government can collect more taxes to pay for bigger safety nets, e.g. catastrophic and bankruptcy coverage.
Another myth.
run75441, NPs were growing quickly before Obamacare and will continue to grow quickly, because of an aging population.
The difference is a market economy would meet demand much more efficiently, resulting in lower costs and lower prices, along with sufficient quantity and higher quality.
So I take it that Maggie and run believe the ACA has been a success. I guess time will tell.
” I am wondering if you think there should be exceptions and/or delays for the very wealthy to file their tax returns? ”
Little John
Seriously? You think there are no exceptions and delays for the very wealthy(and others)?
Geez.
I love the anecdotes and the “I wonders” and the “narrow networks” and the “$880 for a family of four healthcare costs” and the “doctor shortage” presented as some sort of discussion.
Little John, Are you aware you are paying substantially less for that healthcare than people with employer provided insurance?(over $16Gs according to Kaiser) And this is a bad deal? Spare me the details and how “good” your old policy was, anyone with any knowledge knows it is bs.
My insurance is through my wife’s employer. Fortune 50 corp with over 300,000 US employees. Our premiums approach $20Gs a year(more than the usual such policy according to Kaiser which is $16gs). Our network, like every single network in the US is ever changing and shrinking. Case in point, our GP has been in and out of network 4 times in ten years. Once again, this is not something the ACA caused.
Best of all is the doctor shortage thing. Somehow these neanderthals think the answer to the doctor shortage is somehow to let people be barred from seeing a doctor? How ludicrous is that thought process? How absolutely inhuman. You cannot think of a better solution?
This is why I will not get into many discussions with these neanderthals. They are not interested in any facts. They “wonder” about something, but of course they never research and come up with any numbers, but their “wondering” allows them to make something out of nothing, or at best add nothing to any discussion.
Thirty years ago some schmuck “wondered” how many welfare queens drove cadillacs.
What I learned from that is you do not listen to schmucks.
MD shortage. Sheesh.
The Right Wing/Dem Corporatists know the solution to too few tech workers/engineers to satisfy the demands of the various Siicon Valley’s around the country. No you don’t offer higher wages and or retraining to available U.S. tech workers. That would be silly. And costly. Instead you just lobby for a vast expansion of H-IB Visas that allow you to hire eager South Asians. Engineers.
You know what other category of Knowledge Workers countries in East Asia and South Asia produce in abundance fully trained in English language curriculums in Western technologies?
Well yes Medical Schools in the Phillipines, Singapore and India produce an almost unlimited supply of potential primary care physicians. In fact if like me you get your medical care from the Veterans Administration you are just as likely or more to get high level care from physicians named Chang, Joti and Singh. Or Filipinos named Segura.
The idea that any possible shortage of physicians can’t be solved by a resort to a new supply of foreign MDs using the same sort of H-1B visas used by Google is ludicrous. Anglo physicians retiring or limiting practices because they don’t want to accept Obamacare? We’ll let them retire to their Gated Community homes and Concierge Service practices. As Dean Baker has been pointing out for years the only reason for a restricted supply of doctors in the US is the restrictive cartel established by the AMA.
Free Trade in MDs. And shortages vanish. Not overnight. Because it is a 20 hour flight with connections from Hyderabad. So day after tomorrow.
On a related note. We are told that the biggest structural threat to Social Security is in a shrinking worker to retiree ratio. OMG it is going to shrink from 40 to 1 in 1935 to 2 to 1 in 2040! And fertility ratios among middle to upper class Americans are crashing below Replacement Rates!!! Winter or where are we going to get the Night Nurses and Orderlys needed to take care of our Aging Boomers!!!!!!!!
Hmm Costa Rica and the Phillipines?
For those of a more numerical bent you can compare Tables B.1 to B.4 in the annual Social Security Reports that show a shrinking worker/beneficiary ratio right along side immigration numbers that show not just a relative but even an absolute restriction in immigration numbers and ask “WTF?” You can argue deteriorating worker/retiree ratios or the dangers of ‘Open Borders’ but it takes stones to argue both at the same time. Well you can thread that needle. If you translate it to “Less Browns”.
Because “America”
Bruce,
Excellent comment…
And if we had fully computerized diagnostic and treatment records, including images, many of those physician services could be performed without having to use the H-1B visa. There is a lot of fiber-optic cable between the US and India.
While the MD heavy lifting was being done in Hyderabad, I can imagine a new US based job as “bedside manner specialist” being created.
Things might actually improve, and cost lots less. As we found out in the “computer science” profession over the last couple of decades.
“Free Trade in MDs.”
Yes, we need to increase the number or size of U.S. medical schools and import more foriegn MDs. Lowering standards will also increase the supply of MDs. However, how low do we go? For example, we don’t want to import leaded painted toys. India and China can produce all the MDs they want through much lower quality. Here’s a related article:
A College Education Without Job Prospects
November 30, 2006
“The job market for Indian college graduates is split sharply in two. With a robust handshake, a placeless accent and a confident walk, you can get a $300-a-month job with Citibank or Microsoft.
With a limp handshake and a thick accent, you might peddle credit cards door to door for $2 a day.
But the chance to learn such skills is still a prerogative reserved, for the most part, for the modern equivalent of India’s upper castes — the few thousand students who graduate each year from academies like the Indian Institutes of Management and the Indian Institutes of Technology.
Their alumni, mostly engineers, walk the hallways of Wall Street and Silicon Valley and are stewards for some of the largest companies.
In the shadow of those marquee institutions, most of the 11 million students in India’s 18,000 colleges and universities receive starkly inferior training, heavy on obedience and light on useful job skills.
But as graduates complain about a lack of jobs, companies across India see a lack of skilled applicants. The contradiction is explained, experts say, by the poor quality of undergraduate education.
Teaching emphasizes silent note-taking and discipline at the expense of analysis and debate.
“Out! Out! Close the door! Close the door!” a management professor barked at a student who entered his classroom at Hinduja two minutes late.
Soon after his departure, the door cracked open again, and the student asked if he could at least take his bag.
The reply: “Out! Out! Who said you could stand here?” A second student, caught whispering, was asked to stand up and cease taking notes.
“When we are raising our children,” said Sam Pitroda, a Chicago-based entrepreneur who is chairman of the Knowledge Commission and was an adviser to Prime Minister Rajiv Gandhi in the 1980s, “we constantly tell them: ‘Don’t do this, don’t do that. Stand here, stand there.’
It creates a feeling that if there is a boundary, you don’t cross it. You create boxes around people when we need people thinking outside the box.””
geez
Yeah, everyone I know thinks we should have untrained and unqualified doctors enter the US.
EM-I guess you can delay your federal tax filling to October but to my knowledge that is as far as you are allowed.
Why is your health plan so expensive? May I ask you how old you and your wife are? Do you have a very low deductible? Prior to the ACA changes my deductible was $10,000. Now it’s $5,000. Maybe you could get a better deal thru the exchange.
EMichael who said anything about “untrained and unqualified”?
In the U.S. new doctors undergo an extensive period of supervised practice as ‘interns’ working under the immediate oversight of ‘supervising’ physicians before being released to practice on their own. And if they want to enter a speciality or even get certified as a ‘Family Practice’ or ‘Internal Medicine’ practioner have to go before qualifying boards. And anyone who has been in any kind of urban hospital over the last couple of decades has encountered plenty of foreign born doctors. It is just that they managed to beat the lottery and get one of the DELIBERATELY limited spots at a U.S. Medical School.
Now I suppose there is a moral case against skimming the best of the graduates of Indian and Singaporean medical schools to fill slots in America. On the other hand this kind of free market move would create incentives to improve the second tier institutions by opening up the higher level slots in India and Singapore.
Relaxing import quotas on toys or MDs doesn’t necessarily mean allowing lead painted or equivalents for doctors to enter the country, you don’t have to go right over to being a Free Trade Absolutist to grasp the benefits of reasonably controlled open trade in commodities in actual short supply in the importing country. If the MD shortage is real then get those quality MDs where you can find them. And maybe that is not India, maybe it would be Brazil or France or Britain or Italy. But in any event it is nonsense to complain about a shortage of ANYTHING when you have import barriers designed to protect domestic production.
Bruce,
I was making fun of Peak’s “wondering” how bad these Doctors might be.
LJ,
I have a $3000 deductible for both me and my wife. $6000 total out of pocket. You just have no idea what healthcare costs in this country are, as you ignored the average cost I quoted. The ACa didn’t do this:
“Annual premiums for employer-sponsored family health coverage reached $16,351 this year, up 4 percent from last year, with workers on average paying $4,565 towards the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2013 Employer Health Benefits Survey.”
Additionally, the employer pays $14,000 of the premiums, so the exchange would not be an option for us.
Without knowing I would think your old policy does not meet the ACA minimums. Everyone I have heard about with those policies(families) had restrictions on exactly what counted as being credited towards the deductibles(I have heard some horror stories); yearly cap, lifetime cap, etc.
Yeah, I had a lifetime cap of $5,000,000 and maternity wasn’t covered. Of course my wife and I are not going to have any more kids, she’s 40 and I’m 50. We had never even come close to the deductible but the insurance company did reprice any and all bills we received. I remember having our second kid and the hospital people came in and said, “OK. That’ll be $10,000.” We said, “We’re paying cash.” The reply was, “How about $2,000?” We said, “Great”. When we called the anesthesiologists office and said we wanted to pay the bill, where do we send the check? They were dumbfounded. It literally took them 60 seconds to gain their composure.
You’re right, I’ve been out of the “employee” world for so long I don’t know how much these group premiums are. I thought I was getting a bad deal! Of course I am paying about double what the typical employee is paying out of pocket according to the KFF article you cite.
But, more to the point it’s my opinion that premiums will continue to rise due to the adverse selection issue embedded in the ACA. In addition I think that people who buy coverage in the individual marketplace will have to pay for those who are getting subsidized coverage thru the exchanges. Just more cost-shifting.
Don’t get me wrong, I am not bitching, just skeptical about how the ACA will work in the long term.
Joel, Bruce, Little John, Linus Bell, Peak Trade–
ON THE DOCTOR SHORTAGE
First, the problem is not that we don’t have enough doctors. The problem is mal-disitribution. In Manhattan we have plenty of doctors. I can easily make an appointment with a specialist. In poor rural areas,, by contrast, there are not enough doctors. Most physicians don’t want to settle there,and don’t want to raise their families there. So they all flock to the same places: N.Y., L.A., Boston, etc. Training more doctors would not solve this problem. They still wouldn’t go to rural Alabama.
The Affordable Care Act however, does address the problem, by greatly expanding the Physicians’ Service Corps. The Corps gives scholarships to Med Students who agree to practice in an underserved area for a certain period of time (If they don’t, they have to pay back the scholarship). We have found that if we want them to stay in that area, we need to admit more students from low-income families to our medical schools. Research shows that someone who grew up in a poor rural area is far more likely to want to go back there– family ties, a desire to “give back” to the community.
This means admitting more Latinos, African Americans and kids from low-income white families. With the National Service Corps scholarships they can afford to go to medical school. And while their test scores are not as high as those of kids who come from affluent families and went to schoosl that are very good at teaching test-taking skills, we have found that when it comes to clinical courses (caring for patients) the students from low-income families do as well—or better.
Secondly the ACA provides funding for loans and scholarships to produce many more nurse practitioners and physicians’ assistants. Increasingly NPs , PAs and doctors are working together, in teams. If you go to your PCP with a sore throat–and need to be checked for strep, you may well see a nurse practiotioner rather than a doctor. NPs are well trained–they are now getting Ph.D.s In many states, they are licensed to prescribe medication–that trend is growing. Nurse-midwives are delivering more and more babies. Nurse anesthesiologists are assisting doctors in surgery.
Pediatric nurses are caring for children. (In parts of Western Europe healthy children receive almost all of their care from a pediatric nurse, not a pediatrician. This means that pediatricians have more time to spend with sick children.
In group practices like Group Health Cooperative in Seattle, NPs provide much of the care, making it possible for primary care doctors to spend 30 minutes–or more–with complicated patients. In addition, at Group Health, if you need to renew a routine prescription you don’t need to go in to see a doctor. Renewals are done by email and by telephone. Often they are done by NPs. This is the future– e-medicine and telemedicine. Before longt Medicare will be paying doctors for the time they spend emailing patients. All of this means making much better use of a doctor’s time.
In addition, going forward, more and more docs will be working for large organizations like Group Health, Kaiser Permanente, etc. The back office will take care of billing, hiring receptionists, arranging malpractice insurance etc. The doctors who are on salary don’t have to worry about running a business– they spend their time dong what they were trained to do: caring for patients. Having lots of solo and small groups of 3-10 doctors is extremely inefficient–and expensive. When it comes to paperwork, etc., they don’t enjoy the economies of scale that a huge back office enjoys.
Finally, when it comes to finding health care professionals to go to those places “where no one will go” , more and more nurse practitioners are running community health centers. They refer patients to specialists, as needed.. The Affordable Care Act also greatly increased funding for Community Health Centers.
Bottom line: we don’t have to worry about the ACA creating a doctor shortage. In fact the ACA is addressing the problem and solving it.
I have written about this for The Guardian here http://www.theguardian.com/commentisfree/2014/jan/28/obamacare-doctor-shortage-myth.
Bruce Webb–
I agree that doctors from who come here from India and other countries are well-trained.
But their is a “brain drain” problem when we import doctors from countries that need them.
Moreover, there can be a cultural problem. If I come here from China, how well will I understand the needs, fears and desires of a poor Mexican family living in Texas? How well will I understand the culture of an African-American family in Detroit.
I once had a colleague from Egypt. His father was an M.D. who had come here after attending me school in India. He wound up practicing in the rural South. And my friend said “He hated his patients.”He saw them as “dumb rednecks.” No doubt they weren’t crazy about him.
This is why rather than importing more doctors and nurses, we need to train a far more diverse groups of Americans to become medical professionals.
Our doctors and nurses should reflect the diversity of the patient population.
Doctors need to understand their patients–and patients need to trust their doctors,
Linus Bell–
Yes, I can definitely imagine tests being read in a lab overseas.
I saw two interesting articles today. The Daily Mail says that according to RAND around 850,000 previously uninsured people have signed up and paid for a policy thru the federal exchange. Reuters is reporting that insurance companies are already preparing double digit rate increases “in some parts of the country” for 2015 renewals.
Little John–
That’s good news from RAND–though when all of the applications are counted up I thnk the number will be much higher. (This is based on the numbers I have seen in some individual states.)
Equally importantly, millions of people who are now signing up were not uninsured but they were seriously underinsured. If they landed in a hospital or needed expensive medications, their insurance wouldn’t begin to cover them.
Finally regarding premiums climbing by double-digits–the sources for most of these rumors are insurance companies. They’re trying to soften us up so that when they try to hike premiums by “only 9%” we will accept the increases.
In most states, serious hikes won’t work. Too much competion from carriers asking for less, and too much regulation. In 2013 regulators in many states refused to accept proposed premiums that they thought were too high.
Finally many young Americans (under 40) bought insurance both in the Exchanges and outside the Exchanges this spring.
All of them will affect next year’s rates–inside as well as outside the Exchanges. I’ll be explaining this in my next post.
I look forward to the post, but isn’t the health of the enrollees a better predictor, than age, of future premiums?
Little John–
We have no way of knowing about the health of the new applicants since insurers can no longer charge more of they suffer form pre-existing conditions–and thus can no longer ask about their health. So age is the best proxy we have for heatlh. I would argue that the emphasis on how many are 18-34 is misleading.
In general Americans under 40 are much healthier than 50-somethings and 60-somethings Probably focusing on what percentage of those in the Exchanges are 50-64 might be the best way of assessing risk.
Also, for some reason that I don’t understand, people rarely talk about how many children (0-18) are in the Exchange pools. Kids are pretty cheap to insure–they rarely suffer from chronic diseases and rarely need end of life care. (These are the two most expensive categories of health care spending.)
Thanks to the subsidies a great many parents with children who couldn’t afford good insurance in the past are now signing up for coverage. By and large, those parents are under 50 and their children will cost insurers’ little.
” I remember having our second kid and the hospital people came in and said, “OK. That’ll be $10,000.” We said, “We’re paying cash.” The reply was, “How about $2,000?” We said, “Great”. –LJ–
And thus you explain why US healthcare costs have accelerated so much in the last several decades without even realizing it.
You cannot control costs in a system where people outside the system can access the system.
There is a cap on premium increases. The ACA requires a certain percentage of total premiums be spent on medical care or refunds must be given.
Jerry:
You are correct in that there is a cap. 80% for individual and 85% for group. It is in the form of a rebate. We will have to see how insurance companies game the system going into 2015.
Jerry–
Yes, they must send customers a rebate if they don’t spend a certain percentage of premiums on health care. (And in 2013, they were forced to do just that.)
This puts a cap on profits, and how much insurers can spend on marketing, advertising and other administrative expenses.
Insurers really want to avoid the rebates. The whole process of sending out the checks is expensive (lots of paperwork) and from a PR
point of view, it’s a disaster. You really, really don’t want to have to
tell customers “We’ve been overcharging you and now we want to send some of the money back.”
Your article is misleading and is for ” low informed” voters. Nothing is FREE! Someone is paying. Those numbers were BS! Are you a journalist? If so, you need to go back to school. The numbers have been debunked, counting every person, who was just ” shopping” up to 5 and 6 times. Also the govt. is NOT able to say how many have actually paid. Now those are the FACTS.
movingoutofCA (chuckle):
Those numbers were not debunked and are realistic as based on actual enrollment. As far as payment? Est. Exch. QHPs as of May 23, 2014: 7.22M (Paid) / 8.14M (Total) as taken from here:http://acasignups.net/ Charles Gaba is the Nate Silver of the PPACA. Total enrollments are: Individual QHP Range: (9.45M – 16.14M); Medicaid/CHIP (6.03M – 8.41M); ESIs (110K confirmed; up to 8.2M more possible); and Sub26ers (1.63M – 3.13M). Read them and weep lady. Here are two neat graphs by Gaba. One from when enrollment ended and one from May 27th.
http://angrybearblog.strategydemo.com/wp-content/uploads/2014/05/aca_chart_140408_0-150×150.jpg End of Enrollment
http://angrybearblog.strategydemo.com/wp-content/uploads/2014/05/aca_chart_1405091-150×150.jpg May 27th
Of course, you may have some better and documented data other than hearsay; but, I doubt it.