“The Administration is recognizing the grim reality that more Americans have lost health insurance than gained it under Obamacare.”
— Sen. Marco Rubio (R-Fla.), news release, Dec. 19, 2013
This is an emerging line by Republicans: More people have “lost” health insurance or have “canceled plans” than who have gained it through the Affordable Care Act, a.k.a. “Obamacare.” But Democrats have cried foul, with the House Energy and Commerce Committee minority staff estimating that, as a result of the law, no more than 10,000 people do not have health insurance coverage at the start of the year.
So, who’s right? Much of it depends on what you count, how you count it and how carefully the attack line is phrased.
Let’s start with Boehner’s tweet, since he linked to a Daily Caller article that wrongly asserted that the law “left more Americans without coverage than before the law was passed.”
On its face, this claim by the Daily Caller is wrong because the law included a significant expansion of Medicaid, which in just two months has added as many as 3.9 million people to its rolls. (Because of how states report the numbers, some may have already had coverage. Sean Trende at Real Clear Politics has also raised questions about the 3.9 million figure. Update: There are serious issues with the 3.9 million figure.) The article also incorrectly assumes that everyone whose plan did not meet Affordable Care Act standards but who did not sign up for a plan via the exchanges has been left without coverage.
In reality, many people who received notices that their plans were canceled were told they would be automatically enrolled into another plan by the same insurance company. (Here’s an example of such a letter, courtesy of our colleagues at PolitiFact.)
In other words, the person’s health plan was “canceled” but the person was not left “without coverage,” as the Daily Caller asserted. There likely was a seamless transition from one plan to the other, though the premiums might have increased because the ACA requires all plans to have the same basic level of benefits.
Of course, not everyone ended up with essentially the same plan — or liked the options, either from their insurance company or the Obamacare exchanges. Under intense political pressure, the White House ordered an administrative fix that, depending on the actions of individual states, allowed as many as 2.3 million people with “canceled plans” to simply stay on their old plan for at least another year. Thus they also did not lose coverage, contrary to the Daily Caller’s claim.
(Before the controversy ever erupted publicly, many states allowed “early renewals” that in effect allowed people to keep their old plans, usually through the end of 2014. Administration officials thus argue it was not a new concept but basically an extension of an existing timeline.)
Just before the holidays, the administration announced a new catastrophic exemption to fill any remaining gaps in coverage — estimated to affect as many as 500,000 people.
Though Boehner’s tweet had the same wording as the headline for the Daily Caller’s wrong-headed article, spokesman Brendan Buck says the speaker’s main point is that there were “more private plans canceled than private plans enrolled in Obamacare.”
Buck said that there is a “Democratic mindset that as long as there is another plan they’ve found — whether Obamacare, re-enrollment, or the new catastrophic exemption — that negates the fact that people had the plan they had — and potentially liked — canceled in the first place. From our perspective, that is nothing to overlook. In fact, it goes to one of our central arguments against the law — the government deciding what constitutes health coverage. The president promised people could keep their plans. And in astounding numbers that proved not to be true.”
Buck’s point is certainly a valid argument, but the problem is that Boehner’s statement (and those of other GOP lawmakers) could be interpreted as saying what the Daily Caller article incorrectly asserted — that millions of people are lacking coverage, as opposed to being forced into coverage they may not have wanted. (Boehner’s tweet did link to the article, after all.)
Indeed, the number of people who thus far have signed up to receive insurance through the exchanges (2.1 million) is merely a subset of the number of people whose plans were canceled (4.7 million); it makes little sense to compare them because the number of people on exchanges will be a smaller number than the number of people whose plans were not compliant with the law. (At this point, it’s unclear who never had insurance in the first place.) It’s kind of like saying the number of people who only eat apples is smaller than the number of people who only eat apples, oranges or bananas.
We are primarily examining Boehner’s tweet, but aides to Barrasso and Rubio also defended their statements. Emily Schillinger, spokeswoman for Barrasso, pointed to an Associated Press article that laid out the number of canceled policies in each state, coming up with a total of 4.7 million. The number for Wyoming is 3,200. (Barrasso said “thousands and thousands.”) Regarding Wyoming, the AP also notes: “Insurance companies were given the option to renew, and the state insurance commissioner says most of the older plans will be extended for 2014.”
Barrasso “said canceled — because the policies were canceled,” Schillinger said. “The AP says that thousands of people in Wyoming have had their insurance canceled because of the president’s health-care law. We can’t say how many people have had their policies renewed and extended.”
She also provided a link to a Wyoming state document showing that 17 insurance companies are either withdrawing from or not actively marketing in Wyoming as a result of the Affordable Care Act.
Alex Conant, a spokesman for Rubio, noted that the senator’s full statement made clear he was referring to the private insurance market and thus was not including Medicaid. “More Americans have lost their insurance plans (about 4.7 million) than enrolled for insurance through the exchanges (2 million),” he said. “That’s why the administration offered the fire sale in the final days of the enrollment period — to try to improve the otherwise embarrassing numbers.”
The Pinocchio Test
It is correct, according to the AP’s count, that 4.7 million people received a letter saying that their insurance was canceled. From a political perspective, perhaps it does not matter if the transition to another plan was seamless; they still got a cancellation letter, contrary to the president’s famous pledge. But that does not mean that the 4.7 million figure can be easily compared to the number of people signing up for coverage via the exchanges.
Of these three statements, Barrasso gets the closest to framing it correctly. But it is still a question of apples and oranges because listeners might still be left with the mistaken impression that most people with canceled policies ended up with no health insurance.
For instance, this would be a more accurate way for Barrasso to talk about what happened:
“More than 3,000 people in Wyoming had their insurance canceled under the law. We have no idea how many were happy with the insurance choices they were left with, but we do know that there are not as many options in our state and that fewer than 1,000 people have been able to sign up on the Obamacare exchange.”
This is one of those cases where the exact phrasing could make a big difference in the Pinocchio rating. The Daily Caller article by itself would merit Four Pinocchios, while the actual phrasing of Boehner’s tweet is technically correct but a misleading accounting of apples and oranges. In linking to an obviously mistaken article, Boehner compounds any misunderstandings about the point of his tweet.
Moreover, it is worth remembering the enrollment period is only at the halfway point, so the data are incomplete. If Republicans are trying to claim that more people lost private insurance than gained it under Obamacare, the jury is still out and the verdict won’t be in until April 1.
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