Opinion: About Americans ‘losing’ insurance under GOP plan

The Congressional Budget Office has released its initial estimate of the effects of the House GOP’s health-care plan, and one big takeaway is that the bill would reduce federal deficits by about $337 billion over 10 years compared with leaving Obamacare on the books. That’s worth noting, given that Democrats have spent years peddling the fiction that Obamacare somehow saves Uncle Sam money.

But you can also expect a lot of headlines about how many people would “lose” coverage if it is passed. I put “lose” in quotation marks, because it’s clear from the report that a great many of these people would actually be making a choice, not having an outcome forced on them by the government.

The report doesn’t give us an easy-to-read tally of how many people would no longer elect to buy coverage vs. those who would lose something they’d prefer to keep. But there are a couple of key references to this difference in the report’s section on “Net Effects on Health Insurance Coverage” (pgs. 19-21):

  • “… in 2017, the elimination of the individual mandate penalties would result in about 4 million additional people becoming uninsured”;
  • Most of the reductions in coverage in 2018 and 2019 would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they choose to be covered by insurance under current law only to avoid paying the penalties. And some people would forgo insurance in response to higher premiums.” (emphasis added).

Let’s put those figures in context. In 2017, the CBO says the elimination of mandate penalties — i.e., the fines for not buying insurance — would account for 4 million people no longer being uninsured. In total that year, the CBO says 4 million people would become uninsured. The implication, then, is that most if not all of these people would be choosing to become uninsured because they no longer faced a penalty for doing so. (Some of them are listed as having employer-sponsored coverage now, but the CBO report makes clear they, like people in the non-group/individual market, would be choosing not to buy the insurance their employers offer.)

In the two years following that, the number of newly uninsured would rise to 14 million and then 16 million. But again, the CBO says “most of the(se) reductions … would stem from repealing the penalties associated with the individual mandate.” In other words, “most of” the 10 million to 12 million people dropping coverage in 2018 and 2019 would be choosing to do so because they no longer face a penalty for being uninsured.

Put those figures together, and the number of people who choose to drop coverage rather than “losing” it are:

  • 4 million out of 4 million in 2017 (100 percent);
  • about 9 million out of 14 million in 2018 (64 percent);
  • about 10 million out of 16 million in 2019 (63 percent).

That’s a rather different way to look at things.

For all the talk on both sides about replacing subsidies with tax credits, the CBO predicts that over time they will pretty much even out: In 2026, there will be only about 2 million fewer people buying insurance on the non-group market compared to the number who use the Obamacare exchanges today. That’s the same number as estimated for this year — meaning we are still mostly talking about people not buying insurance because they aren’t being forced to buy insurance.

The bad news, if you’re a Republican being asked to support this bill, is that in the meantime the CBO expects a lot of volatility in the non-group market. The number of people in that market today who become uninsured will peak between 2020 and 2022, at 8 million to 9 million. It’s unclear to me why the CBO would expect the switch from a subsidy to a tax credit to take that many people that long to adjust to, given that the tax credit has been designed to act virtually the same as a subsidy. There’s not a good answer in the report.

The biggest change in insured will come in Medicaid. But here, too, there’s some context that’s useful. More than two-thirds of the projected eventual “drop” in enrollment — 5 million out of 14 million, roughly speaking — comes from expansions in states that haven’t expanded Medicaid. Confused? You should be. Essentially, the CBO is projecting these states, such as Georgia, would have expanded Medicaid eventually, but won’t now. How does the agency know that? It isn’t telling. But it is saying 5 million people will “lose” insurance — which they do not have, because those expansions have not taken place — as a result. This is deeply disingenuous.

Not all of these trends are projected to take place at the same speed, so you can’t simply add the Medicaid numbers to the private-market numbers. Still, it’s clear that, at any given moment, more than half of the people “losing” insurance under the GOP plan are either choosing to stop buying it or not receiving Medicaid which they have not been offered in the first place.

***

Keep in mind, the question of whether this is a good plan is, to some degree, an entirely different question. I tend to be underwhelmed by it.

But if you see people railing against it based on the “fact” that millions of Americans will “lose” coverage because of it, just know the real, full story is rather different.

Reader Comments 0

298 comments
BAW
BAW

Great article Kyle.  Many good facts that haven't seen the light of day in other media reports.  WSJ also reported today that the CBO estimate of the people who will "lose coverage" because of the end of the mandate also includes 6 million people on Medicaid!  So the CBO believes that 6 million people now on Medicaid, which is free health care, will choose to drop coverage if the penalty/mandate is terminated.  Truly astounding.  CBO also seems to have forgotten that the penalty is no longer even being enforced by the IRS under their new "don't tell, don't ask" policy.  Also, that there won't be a single insured person remaining in the ACA Exchange plans in another year or two because every insurance company will have pulled out.
It's healthy to have e vigorous debate about the GOP plan and to make some tweaks for the better, but the GOPs in Congress need to not be swayed by a very flawed analysis by the CBO on the # of people who will lose insurance coverage.
Also missing from the analysis is how the GOP plan will affect the 150 million covered by employer provided plans. Most of these people have suffered under ObamaCare as well due to higher premiums and higher deductibles.  They haven't suffered as much as those in the individual markets paying their own way, but that is still a huge part of the health care picture. 

bu22
bu22

@BAW The WSJ also points out how poorly CBO has estimated Obamacare, predicting 26 million taking it this year when it ended up 10 million.  As late as March 2016, it was still predicting 15 million taking it this year instead of 10.

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Putz Cracker
Putz Cracker

I'd just like to say that Doom a classical liberal is like the Tommy Hunter of this here Wingfield thread!  A real principled hero of the anonymous forum!  He's doing a heckuva job, that's for sure.  

And yet, he still has time to attend all our bonfire rallies.  How does he do it, and STILL find time to issue empty challenges around here? 

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Amy Drek
Amy Drek

Did anybody ever notice how difficult it is to make a dissenting comment on a right-leaning thread without it getting removed and the poster getting banned?  That's always been the affliction of the right:  their ideas can't stand on their own merit and their proponents can't weather a challenge.


At least the lefties give you all the rope you need. . .


One last thing to consider:  the vote of a narrow-minded, uneducated racist counts as much as mine does. 


And in a functioning democracy, that's a margin of victory.

Putz Cracker
Putz Cracker

@Amy Drek You better shut it, toots!  Me and Doom a classical liberal will be leaving the Khristian Klown Kollege rally in just a few minutes, and then you better keep looking over your shoulder.

Doom a classical liberal
Doom a classical liberal

@Amy Drek


To date you haven't presented any ideas. You just posted some meaningless drivel. Apparently you can't discern the difference between debate and just offering up insults. 

AndyManUSA#45
AndyManUSA#45

I tried to defend Wingfield but the censor blocked the comment.

Amy Drek
Amy Drek

The CBO announced today that Medicaid could be funded indefinitely with just the money currently being spent on Trump's wig maintenance and skin bronzer.  And NASA could fund its first Mars mission with the money now being spent on his "wife's" penis disinformation campaign. 

AndyManUSA#45
AndyManUSA#45

@Amy Drek @AndyManUSA#45 You lack seriousness. You call a man who gave up an empire to save his country a clown, what does that make you?


I think we all know the answer.

Doom a classical liberal
Doom a classical liberal

I'm watching the breaking news that Trump's 2005 tax returns were leaked. And it appears from the reports that he made 150 million that year and paid 38 million in taxes. Lordy, progs gonna be awful upset when they find out that he actually paid 38 million in taxes. 

AndyManUSA#45
AndyManUSA#45

@Doom a classical liberal That also means that during the years between 1995 and 2005, he made up the loss of 918 million he suffered in 1995, as it would have still been a write off if he had not. 


38 million on 150 million for a business is just about as honest as you can possibly be.

bu22
bu22

@AndyManUSA#45 @Doom a classical liberal Actually, that ignores the losses.  His gross income was $48 million and he paid $36 million of income taxes on it (2 of the 38 were self-employment taxes).  His taxable income (after itemized deductions) was $31 million and he paid more than that in taxes.

SGTGrit
SGTGrit

Wingfield, certainly can't keep up with Bookman. Wooten, he's not.

Doom a classical liberal
Doom a classical liberal

@SGTGrit


Jay has to churn out a lot of columns to feed raw meat to those trolls over there. Their daily hatefest is like a fix for those people.

AvgGeorgian
AvgGeorgian

Don't waste your time arguing the merits of the GOP "healthcare" plan. There is not one. Really.


It is simply a straightforward tax cut. Period. Devious, and so far, wildly successful at camouflaging it's true nature.

Lil_Barry_Bailout
Lil_Barry_Bailout

I don't like it either, but it's better than fascist Obamacare and a lot more than a tax cut.

Doom a classical liberal
Doom a classical liberal

@AvgGeorgian


Tax cuts, which simply return more money to the people that earned it, are "devious". Meanwhile, those who want to vote themselves benefits to be paid for by others are not "devious"? 


Such is life in the twisted worldview of the progs where up is down, black is white, and the sun rises in the west. 

Lil_Barry_Bailout
Lil_Barry_Bailout

Democrats are so unable to deal with nuance and logical thought processes that "they gonna take yo stuff" works on them.

Every.

Single.

Time.

Doom a classical liberal
Doom a classical liberal

@Lil_Barry_Bailout


No doubt. We just witnessed a prog who claims that tax cuts for the people who pay taxes are somehow devious. But of course those who would use the power of the vote to pick the pockets of others are not devious. Unbelievable. 

threejoys
threejoys

It''s too logical, therefore not understandable by the majority of our fellow citizens who make decisions on "headlines" in the mainstream media.  Taking the time to rationalize such an important issues is just asking too much (takes time from texting and the like)  Also, allowing individuals to make independent, free decisions, such as whether or not to purchase personal health insurance, just drives these well meaning do-gooders crazy.  How can we just let people not have insurance?  Well, that's just the American way.  

Some decide not to purchase for totally rationale reasons - others just make dumb decisions -both of which confirm that "we are a free people entitled to make decisions for ourselves as long as they are "legal" decisions.  

Too many fellow citizens just disagree with this, (until something is thrust on them that impinge on their freedoms).

Headlines may not "lie" but they usually fall far short of explaining the "truth"

Lil_Barry_Bailout
Lil_Barry_Bailout

Truth.

The only reform we need is making debts from healthcare non-dischargeable.

Cobbian
Cobbian

Increased costs are going to drive many out.  Uncontrolled cost increases are going to drive businesses to outsource functions to places like Mexico.


Tax credits do not help poor people.  Neither do tax deductions for putting money in spending accounts.  Those are upper and middle class inducements - for people who already have some extra money.  


Cutting back on Medicaid is the wrong way to go, too, because the population is aging and many people do not have pots of money to spend on health care.


Going back to the insurance market is going back to a system that we already know is a failure.  The GOP is going down a losing road.



Lil_Barry_Bailout
Lil_Barry_Bailout

The GOP tax credit to purchase insurance is "refundable".

Means you get it even if you don't pay taxes.

And yes, going to a system where folks have to pay their own way is a losing road when it comes to Democrat voters.

McGarnagle
McGarnagle

@Hedley_Lammar


Back in ancient times, if you were inflicted with a bad health condition or disease, they thought you must have done something really bad to have God curse you with such an affliction. 


Seems like a similar mentality in modern times that poor people make a conscious choice to be in the situation they are in.

Doom a classical liberal
Doom a classical liberal

@Hedley_Lammar


LOL! Interestingly, your author automatically chose to eliminate 35% of the nonworking poor population by saying a lot of them were "retired", "in school", or disabled. So she started with a larger population, then subtracted them out, and then massaged her stats using the subtracted out population to make her claim. LOL! And you fall for that crap! LOL!The poor are the poor no matter what their status, Hedley. 


Sorry, Hedley. I'll go with the Census bureau results over one proggy professor from one of the most proggy schools in the country in U of Wisconsin.


But the funny thing is that even if we used your stats you still can't support your nonsensical claim that lots of these people work 2-3 jobs and still qualify for benefits because they make so little. What a load of BS.