{"id":3810,"date":"2015-11-02T11:02:46","date_gmt":"2015-11-02T16:02:46","guid":{"rendered":"http:\/\/www.dougsbriefcase.com\/blog\/?p=3810"},"modified":"2015-11-05T07:25:44","modified_gmt":"2015-11-05T12:25:44","slug":"what-we-know-and-dont-know-about-obamacare-part-i","status":"publish","type":"post","link":"https:\/\/www.dougsbriefcase.com\/blog\/what-we-know-and-dont-know-about-obamacare-part-i\/","title":{"rendered":"What We Know And Don\u2019t Know About Obamacare, Part I"},"content":{"rendered":"
\"Obamacare's<\/a>

Oba\u00admacare\u2019s third open enroll\u00adment sea\u00adson launched yes\u00adter\u00adday. Here are six things we know about the pro\u00adgram. (Tomor\u00adrow: four things we still don\u2019t know.) Credit:americanlegislator.org<\/p><\/div>\n

Obamacare\u2019s third open enroll\u00adment sea\u00adson has kicked off, begin\u00adning the next chap\u00adter in its tur\u00adbu\u00adlent his\u00adto\u00adry.  Today\u2019s post dis\u00adcuss\u00ades what we know about Oba\u00admacare.  Tomorrow\u2019s<\/a> will dis\u00adcuss what we still don\u2019t know.<\/p>\n

What We Know<\/strong><\/p>\n

Few\u00ader peo\u00adple are unin\u00adsured.<\/strong> How many few\u00ader is a mat\u00adter of dis\u00adpute, but the improve\u00adment is sub\u00adstan\u00adtial by any mea\u00adsure.  HHS<\/span> Sec\u00adre\u00adtary Sylvia Bur\u00adwell cred\u00adits Oba\u00admacare with reduc\u00ading the num\u00adber of unin\u00adsured peo\u00adple by 17.6 mil\u00adlion<\/a> since 2010.   And though you\u2019ll like\u00adly hear this num\u00adber repeat\u00aded (and often round\u00aded up to 18 mil\u00adlion), it\u2019s almost cer\u00adtain\u00adly exag\u00adger\u00adat\u00aded.  <\/strong><\/p>\n

The Cen\u00adsus Bureau esti\u00admates<\/a> that 47.2 mil\u00adlion peo\u00adple were unin\u00adsured in 2010; that num\u00adber had fall\u00aden to just below 36.7 mil\u00adlion in 2014, a dif\u00adfer\u00adence of 10.5 mil\u00adlion.  That\u2019s a lot, but an awful lot less than the 17.6 mil\u00adlion fig\u00adure the Admin\u00adis\u00adtra\u00adtion touts.  Some of that decrease occurred dur\u00ading the economy\u2019s fit\u00adful emer\u00adgence from the worst reces\u00adsion since the 1930s.  By 2013, the year before Oba\u00admacare ful\u00adly kicked in, the num\u00adber of unin\u00adsured already had fall\u00aden by two mil\u00adlion from its 2010 peak.<\/p>\n

That said, Obamacare\u2019s imple\u00admen\u00adta\u00adtion can fair\u00adly be cred\u00adit\u00aded with reduc\u00ading the num\u00adber of unin\u00adsured by 8.5 mil\u00adlion in 2014.  And though that\u2019s only about half the Administration\u2019s inflat\u00aded num\u00adber, it is a sig\u00adnif\u00adi\u00adcant achieve\u00adment.  When the final fig\u00adures for 2015 are in, we can expect that num\u00adber to look bet\u00adter still.<\/p>\n

Most new\u00adly insured peo\u00adple have gained cov\u00ader\u00adage through Med\u00adic\u00adaid, not through the exchanges.<\/strong> The impres\u00adsive decline in the num\u00adber of unin\u00adsured is almost entire\u00adly the result of Med\u00adic\u00adaid expan\u00adsion in 31 states and the Dis\u00adtrict of Colum\u00adbia accord\u00ading to a recent report<\/a> by Ed Haislmaier of the Her\u00aditage Foundation.<\/p>\n

Rely\u00ading on insur\u00adance com\u00adpa\u00adny reg\u00adu\u00adla\u00adto\u00adry fil\u00adings com\u00adpiled by Mark Far\u00adrah Asso\u00adciates and gov\u00adern\u00adment data on Med\u00adic\u00adaid enroll\u00adments, the report found that more than 9.2 mil\u00adlion peo\u00adple gained cov\u00ader\u00adage in 2014.  [That fig\u00adure is con\u00adsis\u00adtent with an 8.5 mil\u00adlion reduc\u00adtion in the num\u00adber of unin\u00adsured, due to pop\u00adu\u00adla\u00adtion growth.]<\/p>\n

While the num\u00adber of peo\u00adple enrolled in indi\u00advid\u00adual pri\u00advate cov\u00ader\u00adage increased by 4.8 mil\u00adlion, near\u00adly 4.5 mil\u00adlion peo\u00adple lost employ\u00ader spon\u00adsored insur\u00adance, for a net increase in pri\u00advate cov\u00ader\u00adage of just under 260,000.  Things were dif\u00adfer\u00adent on the Med\u00adic\u00adaid side, where the rolls increased by near\u00adly nine mil\u00adlion, 8.3 mil\u00adlion of those in states that expand\u00aded their program.<\/p>\n

In all, 97 per\u00adcent of the net increase in new\u00adly insured peo\u00adple was accom\u00adplished by Med\u00adic\u00adaid, not pri\u00advate health insur\u00adance cov\u00ader\u00adage, accord\u00ading to the study.<\/p>\n

Oba\u00admacare is a good deal for unin\u00adsured peo\u00adple with pre-exist\u00ading con\u00addi\u00adtions and those with incomes below 200 per\u00adcent of FPL<\/span>.<\/strong> Oba\u00admacare is a god\u00adsend for peo\u00adple who expect to incur med\u00adical costs that exceed their pre\u00admi\u00adums.  It is also a pret\u00adty good deal for many low-income people.<\/p>\n

Some low-income peo\u00adple who don\u2019t qual\u00adi\u00adfy for Med\u00adic\u00adaid (either because they earn too much or live in a state that hasn\u2019t expand\u00aded its pro\u00adgram) have found that exchanges offer an attrac\u00adtive option.  Such poli\u00adcies are most pop\u00adu\u00adlar among those with incomes below 200 per\u00adcent of the Fed\u00ader\u00adal Pover\u00adty Lev\u00adel<\/a> ($23,540 in 2015 for an indi\u00advid\u00adual, $40,180 for a fam\u00adi\u00adly of three).<\/p>\n

A study<\/a> pub\u00adlished ear\u00adli\u00ader this year by health con\u00adsul\u00adtan\u00adcy Avalere found that more than three-fourths of unin\u00adsured peo\u00adple earn\u00ading less than 150 per\u00adcent of pover\u00adty had obtained cov\u00ader\u00adage either through Med\u00adic\u00adaid or the exchanges.  For those in the 151\u2013200 per\u00adcent of FPL<\/span> range, the num\u00adber fell to 41 per\u00adcent, not over\u00adwhelm\u00ading but still quite respectable.<\/p>\n

There is good rea\u00adson for Obamacare\u2019s rel\u00ada\u00adtive pop\u00adu\u00adlar\u00adi\u00adty in those income brack\u00adets.  In addi\u00adtion to pre\u00admi\u00adum sub\u00adsi\u00addies, those with low\u00ader incomes also receive what\u2019s called \u201ccost-shar\u00ading assis\u00adtance.\u201d  This requires insur\u00aders to keep deductibles and coin\u00adsur\u00adance amounts very low.  A 30-year-old earn\u00ading $17,500 is pay\u00ading less than $60 per month<\/a> in 2015 for cov\u00ader\u00adage (thanks to pre\u00admi\u00adum assis\u00adtance) with a deductible gen\u00ader\u00adal\u00adly around $250 (thanks to cost-shar\u00ading sub\u00adsi\u00addies).  The cost-shar\u00ading sub\u00adsi\u00addies, how\u00adev\u00ader, drop in cliffs.  They become less gen\u00ader\u00adous at 151 per\u00adcent of pover\u00adty, vir\u00adtu\u00adal\u00adly worth\u00adless at 201 per\u00adcent of pover\u00adty, and dis\u00adap\u00adpear entire\u00adly at 251 per\u00adcent of pover\u00adty.  Oba\u00admacare poli\u00adcies haven\u2019t attract\u00aded many peo\u00adple who don\u2019t qual\u00adi\u00adfy for mean\u00ading\u00adful cost-shar\u00ading sub\u00adsi\u00addies.  More on that below.<\/p>\n

Sub\u00adsi\u00addies can land you in trou\u00adble with the gov\u00adern\u00adment. <\/strong>Sub\u00adsi\u00addies (espe\u00adcial\u00adly cost-shar\u00ading sub\u00adsi\u00addies) are clear\u00adly ben\u00ade\u00adfi\u00adcial, but they can be com\u00adpli\u00adcat\u00aded \u2013 both for con\u00adsumers and for the government.<\/p>\n

Since pre\u00admi\u00adum sub\u00adsi\u00addies vary with income, an addi\u00adtion\u00adal $1,000 in earn\u00adings means hav\u00ading to pay, on aver\u00adage, $150<\/a> more for health insur\u00adance.   Earn\u00adings for peo\u00adple in the low\u00adest income brack\u00adets can fluc\u00adtu\u00adate much more than for those with high\u00ader incomes.   Since sub\u00adsi\u00addies are based on an enrollee\u2019s best guess about his or her wages, errors are frequent.<\/p>\n

A Kaiser Fam\u00adi\u00adly Foun\u00adda\u00adtion study<\/a> pub\u00adlished last spring found that 45 per\u00adcent of sub\u00adsidy recip\u00adi\u00adents had received less from the gov\u00adern\u00adment than they were enti\u00adtled to, while 50 per\u00adcent had received too much.  That\u2019s a 95 per\u00adcent error rate, bad even by gov\u00adern\u00adment standards.<\/p>\n

Those who receive too much must pay the IRS<\/span> back with inter\u00adest and may also be sub\u00adject to penal\u00adties.  And every\u00adone who receives a sub\u00adsidy has to file fed\u00ader\u00adal income tax\u00ades, some\u00adthing low-income peo\u00adple are unac\u00adcus\u00adtomed to doing, since the gov\u00adern\u00adment levies no income tax on their wages.  They also have to file an addi\u00adtion\u00adal form to deter\u00admine whether the sub\u00adsi\u00addies they received were too large or too small.  The New York Times reports<\/a> that near\u00adly 1.5 mil\u00adlion peo\u00adple who received sub\u00adsi\u00addies last year failed to file one or the oth\u00ader form.<\/p>\n

They are in for a nasty sur\u00adprise: the law cuts off their sub\u00adsi\u00addies, effec\u00adtive January<\/p>\n

Oba\u00admacare is a bad deal for most unin\u00adsured peo\u00adple with incomes greater than 200 per\u00adcent of FPL<\/span>.<\/strong> As sticky as things can get for peo\u00adple who receive gov\u00adern\u00adment sub\u00adsi\u00addies, life is worse for those who fall off the cost-shar\u00ading sub\u00adsidy cliff.  Pre\u00admi\u00adums and deductibles are much high\u00ader than for those with low\u00ader incomes.  That com\u00adbi\u00adna\u00adtion of pre\u00admi\u00adum and deductibles can be daunt\u00ading, in some cas\u00ades amount\u00ading to 20 per\u00adcent<\/a> or more of their income.<\/p>\n

It is lit\u00adtle won\u00adder that four out of five unin\u00adsured peo\u00adple with incomes between 251 and 300 per\u00adcent of FPL<\/span> have so far pre\u00adferred to remain unin\u00adsured.  Avalere esti\u00admates that 98 per\u00adcent of unin\u00adsured peo\u00adple with incomes over 400 per\u00adcent of FPL<\/span> spurned Oba\u00admacare coverage.<\/p>\n

A study<\/a> by Mark Pauly of the Uni\u00adver\u00adsi\u00adty of Pennsylvania\u2019s Whar\u00adton School con\u00adclud\u00aded that mid\u00addle income peo\u00adple who choose to remain unin\u00adsured are mak\u00ading an eco\u00adnom\u00adi\u00adcal\u00adly ratio\u00adnal choice.   \u201cThe minor\u00adi\u00adty of high risks among the mid\u00addle class unin\u00adsured may gain,\u201d he wrote, \u201cbut most unin\u00adsured will lose and, accord\u00ading to our esti\u00admates, will pre\u00adfer to remain unin\u00adsured at the cur\u00adrent penal\u00adty lev\u00adels for vio\u00adlat\u00ading the indi\u00advid\u00adual mandate.\u201d<\/p>\n

Pre\u00admi\u00adums are going up.<\/strong> If Oba\u00admacare poli\u00adcies were unap\u00adpeal\u00ading to unin\u00adsured peo\u00adple with incomes exceed\u00ading 200 per\u00adcent of FPL<\/span> this year and last, they will be even less appeal\u00ading in 2016.<\/p>\n

How much pre\u00admi\u00adums will rise depends on where you live<\/a> and which plan you\u2019re enrolled in now.<\/p>\n

Health insur\u00adance indus\u00adtry vet\u00ader\u00adan Robert Laszews\u00adki report\u00aded<\/a> ear\u00adli\u00ader this year, for exam\u00adple, that Care First Blue Cross of Mary\u00adland, which has an 80 per\u00adcent mar\u00adket share, sought a 34 per\u00adcent rate hike.  The Blue Cross plan in Ten\u00adnessee, which con\u00adtrols 70 per\u00adcent of the mar\u00adket, asked reg\u00adu\u00adla\u00adtors to approve an increase of more than 36 percent.<\/p>\n

So why did HHS<\/span> recent\u00adly announce that pre\u00admi\u00adums for bench\u00admark plans will rise by an aver\u00adage of \u201conly\u201d 7.5 per\u00adcent<\/a>?  Because some of the insur\u00aders who raised their pre\u00admi\u00adums the most no longer will qual\u00adi\u00adfy as bench\u00admark plans (the sec\u00adond cheap\u00adest pol\u00adi\u00adcy on the Sil\u00adver tier).  Since the all-impor\u00adtant sub\u00adsi\u00addies are based on bench\u00admark plan pre\u00admi\u00adums, most peo\u00adple will like\u00adly switch to new bench\u00admark plans to avoid the big pre\u00admi\u00adum increases.<\/p>\n

Most plans have nar\u00adrow provider net\u00adworks, mean\u00ading that many who change insur\u00aders will also have to change doc\u00adtors.  But there is a sil\u00adver lin\u00ading: so long as their incomes haven\u2019t risen, tax\u00adpay\u00aders will pick up the entire cost of the pre\u00admi\u00adum hike.<\/p>\n

Those who don\u2019t qual\u00adi\u00adfy for sub\u00adsi\u00addies, of course, will have to pay the high\u00ader pre\u00admi\u00adums out of their own pock\u00adets.  But, then again, very few exchange par\u00adtic\u00adi\u00adpants are unsub\u00adsi\u00addized.  Only 14 per\u00adcent<\/a> of those who enrolled through the healthcare.gov<\/a> web\u00adsite are pay\u00ading their own pre\u00admi\u00adums with\u00adout gov\u00adern\u00adment help.<\/p>\n

The next post<\/a> dis\u00adcuss\u00ades what we still don\u2019t know about Obamacare.<\/p>\n

An ear\u00adli\u00ader ver\u00adsion of this post<\/a> also appeared on the web\u00adsite of the Galen Institute.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Obamacare\u2019s third open enroll\u00adment sea\u00adson has kicked off, begin\u00adning the next chap\u00adter in its tur\u00adbu\u00adlent his\u00adto\u00adry.  Today\u2019s post dis\u00adcuss\u00ades what we know about Oba\u00admacare.  Tomorrow\u2019s will dis\u00adcuss what we still don\u2019t know. What We Know Few\u00ader peo\u00adple are unin\u00adsured. How many few\u00ader \u2026 Con\u00adtin\u00adue read\u00ading \u2192<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":3816,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","wp_typography_post_enhancements_disabled":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"nfd_image_url":"","nfd_onboarding_generated":"","footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[16,60,124,1238],"tags":[790,1241,31,70,651,1240,1243,1242,119,623,122,641,54,805,1244,1188,1239,1128,59],"class_list":["post-3810","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-care","category-medicaid","category-obamacare","category-uninsured","tag-avalere","tag-brian-blase","tag-cbo","tag-census-bureau","tag-chris-jacobs","tag-ed-haislmaier","tag-galen-institute","tag-grace-marie-turner","tag-health-insurance","tag-health-insurance-exchanges","tag-hhs","tag-individual-mandate","tag-irs","tag-kaiser-family-foundation","tag-mark-pauly","tag-obamacare","tag-open-season","tag-robert-laszewski","tag-uninsured"],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t\n\t\n\t\n\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t