We always say numbers are like catnip for fact-checking — and it’s especially so when it comes to health care, a regular topic of interest at Fact Checker. So we looked into the recent spin on health-care figures from the White House. As readers will see, in most instances, the White House used accurate figures but characterized them in misleading ways or out of context.
(At the top of this column, readers can view Fact Checker’s revised version of the White House’s video on Obamacare “failures,” with the necessary context added to each claim made in the video.)
“Obamacare Fail #1: Higher Costs: Average premiums are up 105% across the country since 2013”
— White House video
This is a common talking point by President Trump that we’ve fact-checked before, and it’s still misleading.
It’s difficult to make simple comparisons to data from pre-Obamacare plans in 2013. The number of people who qualify for health insurance, and the type of insurance they get, are much different under the ACA than in 2013, before the change. One study found that when adjusting for actuarial value to create an apples-to-apples comparison, individual-market premiums actually dropped after the introduction of the ACA.
In addition, this does not take into account the impact of premium tax credits, which shield 84 percent of people in the exchanges from premium hikes. On average, eight out of 10 marketplace enrollees receive government premium subsidies, and they are protected from a premium increase (and may even see a decrease) if they stay with a low-cost plan.
State-by-state weighted average increases range from as low as single-digit increases to more than 100 percent. For 2017, the average increase in premiums before subsidies was 25 percent, according to the National Conference of State Legislatures.
“Obamacare Fail #2: Fewer Choices. 83 Insurers abandoned the Obamacare marketplace this year alone”
— White House video
The White House appears to be referring to the number of issuers who exited states in 2017, compared with 2016. Some states gained issuers, so the net number of issuers who exited states in 2017 is 68.
The number of issuers varies widely between states. In 2014, an average of five insurers participated in each state’s marketplace, ranging from one to 16 companies in a state. The average number for 2017 is 4.3, ranging from one to 15 companies in a state, according to the Kaiser Family Foundation. Still, the White House noted: “In 2014, 191 issuers offered plans on healthcare.gov. Only 167 issuers offered plans during 2017 open enrollment — a 13 percent decline from 2014.”
It’s important to keep in mind that before the ACA, many rural areas only had one or two carriers. After the exchanges, companies jumped into the market in 2015 and 2016 after the exchanges launched — then left the market after realizing the exchanges weren’t profitable yet. So many states in 2017 are back to the same number of issuers there were in 2014 — which does not necessarily mean there are “fewer choices.”
“Obamacare Fail #3: Fewer Covered under Obamacare exchanges. In 2016, 29% of enrollees dropped off Obamacare exchanges, over 3.6 million people”
— White House video
This is a reference to the difference in the number of people who had selected policies in the exchanges as of January 2016 (12.7 million), compared with the number of people enrolled as of Dec. 31 (9.1 million).
There is constant flux in the individual market; people drop out when they get a job with health insurance coverage, or when they become eligible for Medicaid. So the 3.6 million people do not necessarily represent those who are no longer covered, as they may have obtained coverage elsewhere.
The gradual attrition rate over the course of the year is close to the 2015 rate, notes Charles Gaba, who keeps careful track of enrollment figures at ACASignups.net. Moreover, this statistic ignores that more people are covered under the ACA, and the expansion of Medicaid provided insurance to as many as 14 million people. (The White House disputed our point about Medicaid: “The stat specifically refers to Obamacare’s exchanges and does not mention Medicaid.”)
“Obamacare Fail #4: Less Freedom. In 2015, Americans paid $3 billion in penalties for not purchasing unaffordable health plans that did not meet their needs”
— White House video
The number of Americans who paid a penalty actually decreased by almost 20 percent from 2014 to 2015.
Did they pay penalties because the plans “did not meet their needs” or because they couldn’t afford them? It’s not clear. Those who truly can’t afford insurance can claim a hardship exemption from the penalty. A 2016 Kaiser Family Foundation survey showed that two-thirds of marketplace enrollees were satisfied with their coverage, and 59 percent said it was easy to find a plan that met their needs.
“28 million still uninsured. Nearly 30 million Americans still without health-care insurance coverage. In just the first few months of this year, nearly two million people dropped their Obamacare coverage.”
— White House website
This overlooks the fact that the House GOP plan would boost the number of uninsured by 23 million, and the Senate GOP plan by 22 million, by 2026.
We’ve debunked the 2 million statistic before. It comes from a dubious report issued by Health and Human Services, which found 10.3 million had paid for their first premium in February as of March 15, compared with 12.2 million who had signed up for coverage as of Jan. 31, 2017. (This is similar to the earlier claim about 3.6 million dropping off the exchanges by the end of 2016.)
But the HHS report excludes data from March 15-31, which was usually included in previous versions of the report. Such reports, even ones issued earlier than June 12, included data through March 31. In virtually every state, people signing up for coverage between Jan. 15-31 do not even pay a first premium until March. Gaba estimates that leaves off about 500,000 people. Using enrollment as of Jan. 31 rather than enrollment through Jan. 15 also serves to inflate the purported decline.
“Obamacare is failing the American people: Premiums were supposed to drop, but instead they have soared by nearly $3,000.”
— White House website
Again, this does not include tax credits, which keeps premiums flat or even decreases them for 84 percent of people in the exchanges. And again, this uses data from pre-ACA 2013 through 2017, which are not comparable.
Average insurance premiums in the Obamacare marketplace now are about at the level predicted by the Congressional Budget Office for 2017 when it first evaluated the law in 2009. But premiums have certainly spiked in recent years, as insurance companies grappled with a mix of people in the insurance pools tilted toward people who have chronic illnesses and thus require more care and frequent doctor or hospital visits.
“FACT: when #Obamacare was signed, CBO estimated that 23M would be covered in 2017. They were off by 100%. Only 10.3M people are covered.”
— in a tweet by Trump and the White House
The White House frequently tries to discredit CBO estimates by criticizing their previous estimates, but this is misleading. The CBO was mostly correct on its forecast for the overall number of 23 million people who would gain insurance under Obamacare. The CBO was off in its projection is the makeup of the type of insurance gained in the total 23 million population.
The CBO had originally estimated that the 23 million people would gain insurance through the Obamacare exchanges. But only 10.4 million were participating in the exchanges as of the first half of 2016.
That is only a subset of the number of people who gained insurance. The CBO underestimated the number of people who would gain insurance through Medicaid expansions, due to factors that were unknown at the time. More people than projected signed up for Medicaid — 14.4 million, compared to the projected 10 million. That adds up to 24.8 million total people who gained coverage through Obamacare.
A 2015 study by the Commonwealth Fund concluded, “The CBO’s projections were closer to realized experience than were those of many other prominent forecasters.”
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