Opinion: More truth about GOP health plan’s coverage ‘decreases’

In my first look at the Congressional Budget Office’s estimate for the House GOP’s health reform, a.k.a. the American Health Care Act (AHCA), I pointed out that the agency predicts most of the people set to “lose” coverage would in fact be choosing to stop buying insurance once the individual mandate was removed. It turns out the truth about the GOP bill’s effect on coverage is even more nuanced than partisans are making it out to be.

The question of how many people wouldn’t have coverage in the future hinges in large part on how many people are expected to have coverage in the future under current law, i.e. Obamacare. After all, the CBO isn’t projecting how many fewer people will have coverage compared with today, but rather compared with its projections for the future. And the one thing we know about the CBO is it’s had a really hard time predicting the future when it comes to insurance coverage purchased on the Obamacare exchanges. Just look at this graph, which comes from Avik Roy writing at Forbes:

As you can see, the CBO’s projections for the exchanges have consistently been waaaaaay too high. For 2015, it was off by about 30 percent. For 2016, it originally forecast — on three different occasions — that over twice as many people would buy insurance than the number who actually did so (more than 20 million vs. 10 million). Even when it revised its estimate down to 12 million, it was off by 20 percent.

For 2017, the CBO predicted a 50 percent surge in exchange enrollment with some 5 million new sign-ups, when in fact the increase was only 10 percent with 1 million. For next year, the CBO forecast another big jump in enrollment, even though nothing about our experience with the exchanges up till now supports that prediction.

The upshot, as Roy notes is this: CBO’s baseline of future enrollment, based on actual data so far, likely “is off by 7 to 8 million in future exchange enrollment; hence, the impact of the AHCA is also off by the same amount.”

That’s roughly one-third of the CBO’s projected decrease in exchange-based coverage under the GOP plan. That is about the same proportion as the CBO projected for Medicaid enrollment drops in non-expansion states that, for some reason, the CBO assumed would eventually change course and expand the program after all.

So, one-third of the enrollment “drop” can be chalked up to unrealistic expectations about the future effect of Obamacare, and about half of it is attributable to people choosing not to buy insurance once the individual mandate goes away. That leaves about one-sixth of the decrease possibly being real — about 6 million out of the headline number of 24 million.

Roy’s numbers are slightly different from mine — and, unlike the CBO, he doubts that many people would actually drop coverage due to the elimination of the individual mandate — but he ultimately arrives at nearly the same place:

“You add all that up—7 million off on future exchange enrollment, around 9 million off on the individual mandate’s power, and 3 million off on future Medicaid expansions—the CBO’s estimate of the impact of the AHCA on coverage is off by 19 million, and that the real impact of the AHCA on coverage is negative 5 million.”

There’s no doubt the effect on those 5 million or 6 million people stand to be worse off, and Roy goes on to write about ways the AHCA could be amended to address them while keeping in place most of the big deficit savings from repealing Obamacare.

But there’s also no doubt the discussion about the bill would be vastly different if more people understood and honestly reported on factors such as the CBO’s poor track record of estimating coverage gains and the reasons why some people would drop — not “lose” — their coverage.

Reader Comments 0

264 comments
AndyManUSA#45
AndyManUSA#45

If the Republicans don't come on board with President Trump's budget, should we threaten them with a government shut down, like obama did?


It worked every time, they scattered far and wide.


I, myself, I want the government shutdown, so it really isn't much of a threat.

AndyManUSA#45
AndyManUSA#45

It may be the whole reason Trump got elected, to shut the government down. We have the perfect cudgel to wail on these noisy little establishment hacks and cronies with. 

breckenridge
breckenridge

Trump's proposed budget isn't getting it with republicans.


And then of course there were those who thought they were actually voting for a populist when they voted for Trump.  Boy oh boy do they ever have egg on their faces!

bu22
bu22

@breckenridge Republicans actually debate things. They don't just shut up, vote yes and read the bill later.  They don't blindly accept a crooked Hillary getting rammed down their throat as their nominee.  What's happening is the way things are supposed to work in Congress.

AndyManUSA#45
AndyManUSA#45

Today's History Lesson; In 2008, the Republicans asked to be a part of the discussion on health care in America and the democrats sneered at them. In 2017, the Republicans asked the democrats to be a part of the discussion of health care in America and the democrats sneered at them.


Fact

AndyManUSA#45
AndyManUSA#45

Here is the tradition. If you are Franklin Roosevelt in 1935 and you want to create Social Security—an act that affects Americans very personally—you get the other party in on it. You need them co-owning it, invested in it. You want the American people saying, “Congress did this,” not “the Democrats did this,” because if they say the latter the reform will always divide. FDR got 81 Republicans to vote for it in the House, and 284 Democrats. The same with Medicare in 1965: Lyndon Johnson did all he could to get the GOP on board. A majority of House Republicans supported it.


Welcome to the party, Peggy! I've been talking about this for weeks now and the President hinted on it just this week. 


Yes, such a thing would also absolutely bury the enemy of the people. It's a twofer.


Here's looking at you, Manchin.


https://www.wsj.com/articles/reach-across-the-aisle-mr-president-1489705420?

AndyManUSA#45
AndyManUSA#45

@Resist Trump @AndyManUSA#45 Not as crazy as obama to allow iran's seat on the UN human rights commission to go unchallenged was.


It's a whole new world, fidel. Better fasten your seat belt.

AndyManUSA#45
AndyManUSA#45

Just wondering, would the long overdue reunification of the two Koreas, with China's full acceptance, be enough of a diplomatic achievement for President Trump to earn a Nobel Peace Prize? Yes, it is a rather thorny question, isn't it? I expect we shall soon find out.


Here's looking at you, kim jong.

AndyManUSA#45
AndyManUSA#45

This would also be a way to seriously cut defense spending, for those so upset with it.

Visual_Cortex
Visual_Cortex

And Pinal county, AZ was left with no insurer when Aetna left. 


So that is one (1) county with no insurer.

And you're blathering about "most" of the states going without an insurer because of the "implosion". uh huh.


breckenridge
breckenridge

You can't talk about wasted money without mentioning by far and away the most wasteful government entity, the Department of Defense.  They have no idea where their money goes, and are so g.d. arrogant they insist they're too big to be accountable.


Fire the clowns running the show. Get some accountants in there.

Starik
Starik

@breckenridge Wouldn't that be bad for our heavy industry? And all those overpaid contractors?

Doom a classical liberal
Doom a classical liberal

@Starik @breckenridge


Lots of fat that can be trimmed from the military- especially in procurement. And making our allies pay for more of their security instead of relying on our security blanket is a must. Overseas bases protecting other countries cost a fortune. They need to pay more. 

breckenridge
breckenridge

@Doom a classical liberal @Starik @breckenridge 

Actually, as Ron Paul repeatedly and correctly pointed out, overseas military bases are a complete waste of money and should be close.

The Department of Defense should be for exactly that - defending America. We don't need to be pissing away money stick our noses in foreign conflicts, sticking our noses where they don't belong.

SGTGrit
SGTGrit

Get on the subject of the VA that continually fails veterans as the counter argument to the lefts love affair of single payer healthcare and they go ballistic with unsupported facts, polls and surveys from suspect sources who have zero first hand experience with the VA. Geez.

Doom a classical liberal
Doom a classical liberal

Well, we've already seen the predictable answer down below on what ails the VA. The progs sure enough will say its " a funding problem" So what happened when we increased funding for the worst of the VA hospitals in the VA scandal???


“After the scandal hit in 2014, money poured into this place like there was no tomorrow. The annual budget was increased more than $100 million per year and yet wait times continue to get worse. Veterans continue to die,” he said.


And sure enough what's the problem? Yep. An endless parade of incompetent bureaucrats. 


"Rima Nelson, the current director, is the seventh person to head the Phoenix VA since the scandal broke in 2014 – exposing a consistent and chronic pattern of long wait times, canceled appointments and fraudulent record-keeping. Dozens of veterans died waiting for care that never came."


"When Nelson headed the St. Louis VA from 2009 to 2013, the VA was forced to notify 1,800 patients that they potentially were exposed to Hepatitis and HIV because dental instruments weren’t properly sanitized. A short time later, the facility closed down its operating rooms for the same reason."


Following the St. Louis fiasco, Nelson was sent to the Philippines for three years to head the VA hospital there and then was reassigned to Phoenix."


“We've had seven directors in 2 ½ years, each with more baggage than the last,” Coleman said.


And progs want health care to be turned over completely to a bunch of incompetent gubment bureaucrats??? What is wrong with these people?

Starik
Starik

@Doom a classical liberal I'm sure the VA does things well, like prosthetic limbs and the care for people brain damaged from explosions. They could do better if they didn't have to take care of vets and their families whose problems are unconnected to their military service. Government does things well when properly organized and led. The military and State Department, the CDC, the FBI, the CIA, dozens of agencies.

Doom a classical liberal
Doom a classical liberal

@Starik @Doom a classical liberal


I don't bemoan the people that work for the VA. My issue is that what has happened with the VA, and also with the CDC, is that it has become a monstrous bloated bureaucracy that is so entrenched that reform is all but impossible. 


The 60 minutes special on Obama's last chief of the VA, a guy brought in to reform it, tells the story behind the sheer size and scope of this bureaucratic nightmare. And what people have to understand is that this problem is endemic to large bureaucracies that grow in size and scope not to do a better job for the people they are there to help but to increase their own size, scope, and power. 


And for that matter take a look at the CDC and look at all the things that the CDC now weighs in on that are beyond the original scope and mission of the CDC. Its original mission was epidemiological diseases. 

Starik
Starik

@Doom a classical liberal @Starik Sure, the CDC has expanded into PC projects; blame the pols who directed them to do it. They continue to do a great job with their core mission because they're properly run and funded. Health insurance companies are huge bureaucracies too, driven by the need to deal with payment and negotiations regarding bills from hospitals and other providers. A good government agency taxed with treatment rather than making a profit would need much less bureaucracy.

Doom a classical liberal
Doom a classical liberal

@Starik @Doom a classical liberal


" Health insurance companies are huge bureaucracies too"


Not quite. And if that were true then there lies the difference between a private system and a federal system. A private system can simply fire or layoff bloated staff. They do it all the time.  Do you have any idea how hard it is for a govt employee to be fired? Its nearly impossible to whittle down a govt bureaucracy. Name one federal bureaucracy that's been cut down to size. Just one. 


 "A good government agency taxed with treatment '


Isn't that what VA care and Medicaid are taxes with? And with poor results. 


"rather than making a profit would need much less bureaucracy." 


Completely fallacious. Everyone knows that profit driven enterprises are leaner than gubment bureaucracies. And the small profits that they squeeze out more than compensate for the superior delivery of services than what a gubment entity can provide. 

Starik
Starik

@Doom a classical liberal @Starik It's "government." Supposedly it's responsibility is to the people, all of them. What about the State Department? It's very hard to get into the foreign service and they have an up or out model that gets rid of the unproductive. Replace our current system with one that is based on treating people, not manipulating a forest of billing documents.

Doom a classical liberal
Doom a classical liberal

@Starik @Doom a classical liberal


Well, I'll agree with you on the forest of billing documents. Milton Friedman noted that back in that time we talked about around WW2 there were not many people involved in your treatment for a hospital stay. Today, between insurance companies and govt there are about 7 times more pencil pushers. Which is why I favor going to a medical savings account system. Give people MSAs, let them pay directly for services, let them negotiate directly for transparent pricing, and get both the govt and insurance out of the way for all the smaller stuff. Have govt and insurance cover only the truly catastrophic stuff like heart attacks, Stroke, cancer, chronic illnesses like MS, etc. Only then will you see prices drop. Otherwise it does not matter if its a public or private system as long as you have a 3rd payor paying for items which are not catastrophic. 

Starik
Starik

@Doom a classical liberal @Starik People on the wrong side of the IQ bell curve couldn't handle MSAs. What percentage of people don't save for retirement? What percentage lives from paycheck to paycheck? These folks will drop like flies and rot in the streets unless somebody gets there while they're fresh and eats them. Or... they could storm the Bastille and start relieving the upper classes of their heads. And their kids? Will mama crack/booze/meth head open accounts for them? 

Doom a classical liberal
Doom a classical liberal

"No providers? MOST states and counties?

Um, sure. This happens when?"


Not sure what planet you live on VC. But here on Earth, in the U.S. of America about a third of all counties are down to a single insurer after several of the big names like Aetna/Coventry, Humana, and United pulled out. Plenty of other counties like here in GA only have 2 insurers left. And those insurers have very, very skinny networks that a lot of Doctors don't participate in. 


Again, What planet are you living on?


http://time.com/money/4470574/obamacare-providers-2017/


And Pinal county, AZ was left with no insurer when Aetna left. 


http://www.politico.com/story/2016/08/the-county-obamacare-forgot-227251

Doom a classical liberal
Doom a classical liberal

@MarkVV @Doom a classical liberal


Nope. The problem is gubment and 3rd party payors. 


As Milton Friedman and other economists have noted Health care used to comprise 3-5% of national income before the advent of 3rd party payors. 


And if you plot it on a graph you see the steady rise in health care costs as a % of national income coincides perfectly with the rise of Medicare and Medicaid. The empirical evidence is overwhelming, sir. 

Starik
Starik

@Doom a classical liberal @MarkVV I may be wrong, but the explosion in health care costs came after WW2. Before? Limited drug availability to treat disease and medicine was less complicated; the invention of EKG, MRI, countless new drugs have raised costs and extended the national lifespan. Older people who would have quietly died are now treated extensively, effectively and expensively. That and profiteering by Big Medicine have cost a lot of money. We need to rethink the system completely and that will step on a lot of wealthy and influential toes.

Doom a classical liberal
Doom a classical liberal

@Starik @Doom a classical liberal @MarkVV


You're fairly accurate. The explosion in health care costs began during WW2 as a result of govt distortions in the labor markets. 


During inflation driven competition for workers companies had to find new ways to compete for workers. And the chief new way was to offer employer provided or 3rd party health care. And that was when costs began to escalate and those costs really escalated with the advent of Medicare and Medicare. Its just human nature, really. When people perceive that someone else is paying the bill- whether insurance or govt, then people tend to not care as much about containing costs because in their view its not their money- the insurance is paying or Medicaid is paying. 


I'll agree with some of what you said regarding medical advances. However, medical advances and new drugs have always been made. So that's only part of the escalation. 


Govt has a role imo. I think govt should be more about demanding transparency in medical pricing, demanding that medical schools open up to more applicants, and I would be ok with Medicare negotiating with the drug companies though I fear the end result is going to be less life saving drug innovation. 

Starik
Starik

@Doom a classical liberal @Starik @MarkVV Much routine care could be handled by PAs and RNs. The MDs could be saved for serious work. Like the public education system, we need to take a fresh look at everything. If government is led properly and financed adequately it works.

MarkVV
MarkVV

@Doom a classical liberal @MarkVV There i s no evidence regarding a single payer system in the US, period, because there has never been a single payer system in the US. What we know is that the pre-Obamacare system of private insurance failed miserably. 

AndyManUSA#45
AndyManUSA#45

There is nothing in the Constitution that says the U.S. has to maintain a District Court system at all. A Supreme Court, yes. There it is in Article 3. But Judge Robart's or Judge Watson's perch? Tell me where the Constitution specifies that. Nor does the Constitution say anything about judicial compensation; perhaps it should be zero. Who knows what the ingenuity of man might discover?


Now we're talking. Burn it to the ground. Eliminate it.


https://pjmedia.com/rogerkimball/2017/03/16/grandstanding-judicial-supremacy-must-end/

Starik
Starik

@AndyManUSA#45 Of course the Constitution was wrong about having three branches of government. Eliminate the judicial branch because it impedes Trump?

AndyManUSA#45
AndyManUSA#45

Rand Paul Responds to John McCain: Senator From Arizona Is "Unhinged" and "Past His Prime"

You can't sneak nothing past old Rand.



SGTGrit
SGTGrit

The best argument against a single payer system is two letters, victor alpha or VA.

Hedley_Lammar
Hedley_Lammar

@SGTGrit Veterans love the VA


The best argument for a single payer system. Basically every other first world country on the planet has some form of universal coverage. They are healthier and live longer. They consider it a human right and cant imagine doing it any other way. 

SGTGrit
SGTGrit

@Hedley_Lammar @SGTGrit  "Veterans love the VA" Wrong...I'm a veteran been to VA facilities and no vet's don't love the VA. Don't know where you're getting your information about every other first world country on the planet but we're not every other country we're the USA and we set standards we don't follow them.

Starik
Starik

@Hedley_Lammar @SGTGrit I'm a veteran, and never needed healthcare from VA; that should be reserved for people who have service-connected disabilities. The problem is nobody wants to fund the VA to the level of its mandate.

Hedley_Lammar
Hedley_Lammar

@Starik @Hedley_Lammar @SGTGrit  I'm a veteran, and never needed healthcare from VA; that should be reserved for people who have service-connected disabilities.


My Dad ( retired Air Force ) feels the same. But a few years ago he had a stroke and his health has deteriorated a bit. So he uses the VA for certain things. 


They help a lot of people. And the people who work there are usually dedicated to providing service for our Veterans. Something they wouldn't get if their care was privatized. 

Doom a classical liberal
Doom a classical liberal

@Hedley_Lammar @SGTGrit


Veterans love the VA? HAHAHAHAHAHA!


My family won't let my Dad go near the VA in Montgomery. It has a terrible reputation. 


The VA outpatient clinics here in metro Atlanta are okay with most vets. But the big facility down on Clairmont is a nightmare. They triple book, the wait for an appointment can be hours and hours, just a really poorly run facility. 


Just another example of Hedley speaking of something of which he has no knowledge. 

SGTGrit
SGTGrit

@Hedley_Lammar @SGTGrit  Hedley, have you ever been to a VA facility? Have you ever served? Probably the true answer is no to both questions. So where are you pulling your surveys and polls? Probably from where the sun never shines.

SGTGrit
SGTGrit

@Starik @Hedley_Lammar @SGTGrit  Oh please money has been thrown at the VA for years by many administrations with no positive result. Go to a facility and witness for yourself the administrative and medical support people they hire. The only bright spot on occasion are the private sector specialty providers who volunteer their time. Ask any of them what they think of the VA personnel and you'll get an earful of criticism.

Doom a classical liberal
Doom a classical liberal

@SGTGrit @Starik @Hedley_Lammar


I'm sure there are plenty of good people who work for the VA. But the problem is one that's particular to gubment agencies. They become behemoths with entrenched and bloated bureaucracies who spend more time and energy protecting their turf then they do ensuring our vets are taken care of.