“Is the Affordable Care Act Working?” reads a recent New York Times headline. The editors then consider a series of questions, the first of which is pretty basic: “Has the percentage of uninsured people been reduced?”
Their answer: yes. So, problem solved, right? Not quite.
The devil, as they say, is in the details. And the details show that it’s not as simple as getting more people insured. A new report from health care expert Ed Haislmaier — one based on actual enrollment data, not surveys — illustrates two facts that should give us pause.
One is that the decline in the number of people who are uninsured isn’t as high as it may seem at first glance. The other is that more than two-thirds of the gain in coverage is due to an increase in the number of people in Medicaid, the federal government’s health care program for the vulnerable poor.
This isn’t exactly what Americans were led to believe would happen when the Patient Protection and Affordable Care Act, often referred to as Obamacare, became law.
Let’s look a little closer at the first point. Why isn’t the number of newly insured people as high as it might seem?
Proponents of Obamacare, after all, can point to the 6.2 million Americans who have been enrolled in individual-market coverage since Obamacare took effect. But you have to take into account the 3.8 million who lost their employer-based coverage during the same period. As a result, the number of Americans who gained private health insurance increased by a bit less than 2.5 million in the first half of 2014.
In short, Haislmaier shows, decline in employment-based coverage offset 61 percent of the increase in individual-market coverage.
Why would so many people be losing employer-based coverage? Because of the negative incentives built into Obamacare. It’s cheaper for many employers (who might otherwise face steep rises in coverage costs or fines from Washington) to stop offering coverage altogether and let their employees fall into government-run programs.
Now let’s consider the second point. During this same period, enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) increased by almost 6.1 million individuals. Of the 8.5 million total individuals who gained health insurance coverage, 71 percent of that net coverage gain was due to Obamacare’s expansion of Medicaid to able-bodied, working-age adults.
“The inescapable conclusion,” writes Haislmaier, “is that, when it comes to covering the uninsured, Obamacare so far is mainly an expansion of Medicaid.”
This is hardly what Americans were promised. Or what they expected when President Obama last year said that Obamacare is “doing what it’s designed to do — deliver more choices, better benefits, a check on rising costs.”
Today, the president touts the millions of Americans who have gained coverage. But we don’t hear much in the way of context. Left unsaid is that a large number of the 6.2 million cited above already had individual or employer-based coverage but were forced by Obamacare to get new coverage.
Also unmentioned is the fact that the 6.1 million new Medicaid enrollees are all able-bodied, working-age adults who are being given substandard government coverage in lieu of what they really need: a job.
And we certainly don’t hear much to contradict the much-hyped “check on rising costs.” “In eleven states, premiums for twenty-seven-year-olds have more than doubled since 2013; in thirteen states, premiums for fifty-year-olds have increased more than 50 percent,” writes health care expert Robert Moffit, Ph.D., in a new report.
It doesn’t take a medical degree to see that Obamacare is ailing. The sooner it’s repealed, the better.
Ed Feulner is founder of The Heritage Foundation