January 17, 2017 at 3:00 AM
"What Senator [Charles] Schumer wants to try to ignore is the fact that Obamacare has failed the American people. Millions of people have already lost their health care."
— House Majority Whip Steve Scalise (R-La.), remarks to reporters, Jan. 9, 2017
"For the tens of millions of Americans who will lose their health care if the ACA is repealed, I vote no. #MakeAmericaSickAgain"
— Schumer (D-N.Y.), in a tweet, Jan. 11
These dueling quotes are a good example of political rhetoric run amok. Either tens of millions of people will lose their "health care" if Obamacare is repealed — or millions have already lost their health care.
How is an intelligent voter supposed to understand this? Let's explain what's going on here.
First of all, "health care" is not necessarily the same as having health insurance. Both Scalise and Schumer are incorrectly assuming that if your health coverage changes, you have lost your "health care."
As a practical matter, when people move in and out of the workforce — or change jobs — their health coverage often changes. One of the goals of the Affordable Care Act, a.k.a. Obamacare, was to require a standard set of benefits and consistent rules (such as no ban on coverage for preexisting conditions or no lifetime caps on coverage) so that the type of health coverage was relatively consistent.
The Obama administration says that about 20 million people have gained health coverage as a result of the ACA, a figure that seems reasonable.
Certainly, the percentage of Americans without health insurance has also dropped steeply, further indicating that the law has helped more Americans gain insurance coverage. The percentage of people under the age of 65 without health insurance has dropped from 18.2 percent in 2010 to 10.4 percent in the first half of 2016, according to the Centers for Disease Control. The percentage of people without health insurance for more than a year has been cut in half, from 13.3 percent to 6.1 percent.
So how does Scalise argue that "millions of people" lost their health care because of the law? He is relying on an outdated and inaccurate talking point.
Chris Bond, a spokesman for Scalise, pointed to an Associated Press article from 2013 stating that 4.7 million people had received notices that their health plans had been canceled because they did not comply with the law and they would need to obtain new insurance. There were a number of problems with the AP's count — some numbers of individual states were higher than reported — but the report did not mean people lost their health care.
In fact, there was such an outcry over the reports, given that President Obama had promised that "if you like your plan, you can keep it," that the Obama administration rushed to issue waivers that would allow people to keep their plans. Forty states accepted the waiver policy — which in most cases remains in effect until December 2017. So a vast majority of the people who might have received notices actually were able to keep their plans, even up until today.
The individual insurance market has a lot of ebb and flow, with people moving in and out of it as they change jobs, so the odds are many people who might have been affected by plan terminations would have already switched plans. One study found that in the 2008-2011 period, only 42 percent of policyholders in the nongroup market retained that coverage after 12 months, with many moving to an employer-provided plan when obtaining a new job.
There appears to be no research that has determined exactly how many people had their policies canceled because the health insurance did not comply with the ACA. A 2013 survey by the Urban Institute indicated that 2.6 million people — about 18 percent of policyholders — reported receiving notices of insurance coverage cancellation. The survey was taken in December, after the waivers were announced, but people may have been confused about the status of their plan. A follow-up survey in 2014 found that only 400,000 people had received a notice of cancellation, indicating the waivers were having an effect.
Lisa Clemans-Cope, one of the Urban Institute researchers, said it was reasonable to assume that the 2.6 million figure was inflated by people who initially got a cancellation letter but later received a waiver, but she said there was no data to confirm that.
In any case, Scalise is relying on an inaccurate, out-of-date estimate — and somehow assuming that these people lost their "health care." The odds are most of the people who received notices actually got a waiver — and in any case would have shifted out of the nongroup market by now anyway.
(Some Republicans are more careful in their phrasing. Sen. Cory Gardner of Colorado recently caught himself in mid-sentence from making the same mistake as Scalise: "People in Colorado have lost their health insurance thanks to Obamacare, had their health insurance canceled.")
Now let's look at Schumer's statement, which is echoed in tweets by many other Democrats.
Schumer is basing his statement on an Urban Institute analysis that nearly 30 million people would lose their health insurance if the GOP partially repeals the Affordable Care Act and offers no replacement, thereby crashing the individual insurance market. If that happens, Urban estimates it would boost the number of uninsured by 30 percent. (This estimate also played a role in a Four-Pinocchio claim by Sen. Bernie Sanders [D-Vt.] that health-care repeal would mean 36,000 people a year will die.)
[Update: The Congressional Budget Office on Jan. 17 released an estimate that the repealing parts of the law without replacement would result in an increase in 27 million Americans without insurance once the Medicaid expansion is eliminated.]
In other words, it's a worst-case scenario — and Republicans repeatedly have said they will come up with a replacement plan. President-elect Donald Trump reiterated that in an interview with The Washington Post, insisting that he had the goal of "insurance for everybody."
(Note: For complex legislative reasons, Republicans cannot fully repeal the Affordable Care Act unless they garner at least eight Democratic votes in the Senate. They can repeal some parts, such as the requirement that everyone must buy insurance, under a fast-track process called reconciliation that only needs 50 votes. But other parts of the law, such as the requirement that insurance companies must offer policies to people with preexisting conditions, require 60 votes for repeal. If the mandate is removed but insurance companies must keep offering policies, many experts say the individual insurance market may collapse.)
Schumer spokesman Matt House noted that in 2016 the GOP passed a law that would have partially repealed the ACA that was vetoed by Obama. Of course, lawmakers knew at the time it would be vetoed and so there would be no consequences for not having a replacement law in hand. But House argues that the Republicans have had six years to craft a replacement plan and so should be judged accordingly, on the law they approved last year.
House justified the language equating "health insurance" to "health care" by pointing to a number of studies that have demonstrated the impact of the ACA. For instance, a study compared low-income adults in Kentucky and Arkansas, which expanded Medicaid, to low-income adults in Texas, which did not. The study found that the Kentuckians and Arkansans received more primary and preventive care, made fewer emergency departments visits and reported higher-quality care and improved health. Similar results were found in a different study of adults who bought insurance on the marketplace exchanges.
Again, this presumes that Republicans will not offer anything to replace the Affordable Care Act. That would be politically risky, as demonstrated by the consistent attacks on Obama, even today, that he took "health care" away from people.
Scalise's assertion is ridiculous and worthy of Four Pinocchios, given the documented expansion of health-insurance options and the steep decline in the number of the uninsured Americans under the Affordable Care Act. While perhaps 2 to 3 million people received notices their plan would be terminated, ultimately most received a waiver that allowed them to keep their plan. Now, it is quite possible people learned that their health insurance became more expensive — but they did not "lose their health care."
In any case, Republicans should not be relying on talking points that do not reflect what has actually happened in the insurance market since the law went into effect.
Schumer and other Democrats run the risk of falling into the same trap. They are citing a worst-case scenario that likely will not come to pass. In any case, health-insurance options may change, but that does not automatically translate into a loss of "health care." Given the current absence of a GOP plan, at the moment this is more of a Two-Pinocchio claim. But the Pinocchios could increase as debate over the law unfolds. Democrats should make clear this is a worst-case estimate, not an established fact.
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