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ACA Agonistes
The ACA's Questionable Success in Insuring the Uninsured

Six out of ten Americans insured through the Affordable Care Act were previously uninsured, according to a new Kaiser Family Foundation survey. Previous investigations of the ACA found much lower proportions of the previously uninsured in the new ACA exchanges. This suggested that the law wasn’t achieving even its own goal of expanding coverage. So at first glance, this new survey is great news for supporters of the law who are looking for evidence that Obamacare is making a dent in the number of uninsured.

But once you dig deeper into the data, things get complicated. NYT:

Most of the uninsured had been without coverage for two years or more, and 45 percent said they had been without coverage for at least five years, the foundation said in a report about people in the individual insurance market.

A majority of people with new health plans purchased inside and outside the exchanges rated their coverage as excellent or good and said they were generally satisfied. But four in 10 said it was difficult for them to afford their share of the premiums. […]

The survey found that people in the individual insurance market had been affected by the health care law in different ways. Thirty-four percent said they and their families had benefited from it; 62 percent said they had not.

In other words, nearly half of those who said they were previously uninsured actually had insurance sometime in the past five years. Whether it’s fair to call these people “previously uninsured” is a hard question, and in fact there are many outstanding questions about what our uninsured population is really like. Perhaps some of these people were between jobs and would soon have gotten insured again. Perhaps they had insurance but could not afford their premiums (a problem unlikely to go away under the ACA). Whatever the reason why they had and then lost insurance within the past five years, this kind of churn complicates the narrative about the ACA’s march to universal coverage.

Even more telling is the fact that 62 percent of those surveyed don’t think the law benefited them—even though presumably a good number of that 62 percent were “previously uninsured.” Apparently the American people don’t think just getting insurance is that much of a benefit. With premiums rising year after year, and even people with insurance having problems accessing care, it’s no wonder.

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  • oscabat

    This is disappointingly weak analysis that does not do much more than summarize the cited article from the New York Times. It’s unfortunate that a simple copy-paste only appears to reinforce the narrative already assumed in the writer/editor’s mind. Let’s start with the fact that the URL of the article states “sham victory.” How embarrassing.

    The article’s editor takes the most pessimistic viewpoints, whereas I read that nearly half of the previously uninsured had not been able to obtain coverage within the last five years – many likely due to pre-existing conditions or financial impossibilities.

    Most importantly, there is absolutely no consideration as to why 62% do not believe that the law did not help them. From my experiences, I can consider several. For one, some Americans refuse to accept that the ACA could possibly have any benefit because of the highly polarized political environment where admitting that the ACA did help would give some semblance of legitimacy to the Obama Administration (which can do absolutely nothing right in the perspective of many).

    Two, many people are ignorant to the challenges that others had faced when attempting to obtain and maintain health insurance coverage before the advancement in protections that the ACA enforced on insurance carriers (guaranteed issue; unlimited annual and lifetime benefits; regulation of pricing due to age, gender, and health status; guarantee of essential health benefits such as maternity care and mental health services; etc.). These are issues that many had not yet come to terms with but will never have to experience due to the protections provided under the ACA.

    Speaking of ignorance, the New York Times article states that 20% of individuals did not know the cost of their premiums and 40% were not aware of their deductible amounts. Many people upset also chose to purchase insurance outside of the marketplace and therefore could not receive any subsidies. How many did so either because they refused to accept change that the Obama Administration enacted or because they were unaware of the options available to them?

    My point of view comes from guiding (primarily) cancer patients through the complicated process of insurance for three years prior to the enactment of the broadest measures of the Affordable Care Act (from 2010-2013) as well as then spending a year acting as a health coverage guide to assist people in enrolling in health insurance on a state-run marketplace.

    I will absolutely acknowledge that the Affordable Care Act is not a perfect law (I would have preferred universal healthcare). I will also admit that the rollout for perhaps the most comprehensive and broad policy change and IT project in recent years was haphazard and lacked clear leadership that would have facilitated an easier transition. But I will not accept shallow reasoning that only seeks to affirm what the author wanted to hear.

    • John Wondra

      This is biased speculation and nothing more.
      If your point of view comes from prior experience with cancer patients, then you know that the “pre-existing condition” canard is a false proposition. Many people with “pre-existing” conditions were able to obtain coverage, with honest disclosure, prior to the ACA.
      You take the article’s assessment of lack of coverage to equate to:
      “had not been able to obtain coverage.”
      That is false, and you know it; many people had no coverage by choice, rather than an inability to obtain it.
      Your speculation about coverage and dissatisfaction reflect a pre-existing bias toward government control of choice, scope and price, all of which are better-served by market than regulation.
      Before you offer so much subjective “analysis,” you should be up-front about your bias and refusal to consider alternatives to your speculative
      “explanations” of a study you chose not to objectively analyze.

      • oscabat

        Mr. Wondra apparently lived in a fantasy world where the concept of medical underwriting did not exist when attempting to purchase health insurance prior to the existence of the Affordable Care Act. What a much happier place this must have been. In my United States, only 5 states had prohibited medical underwriting prior to the ACA, and they all had the highest premium rates in the country.

        Mr. Wondra is accusing me of lying when I claimed to help individuals apply for health insurance who were ultimately denied or offered policies with unaffordable premiums who then still were forced into a mandatory pre-existing condition waiting period which lasted from 12-24 months, depending on the state. If Mr. Wondra is interested in learning about these individuals, he could at least attempt to perform a Google search to read countless anecdotes and studies to this effect. He must not realize that an estimated 5 million (of the 45 million) were deemed “uninsurable” by health insurance companies. The majority of these “uninsurables” were older individuals between 60-64 who have high risks of health issues.

        Mr. Wondra attempts to insert a red herring by arguing that many individuals had no coverage by choice. In no way did I attempt to represent the issues of those people which I willingly acknowledge do exist. But if we are to consider them, then I will only anecdotally reflect on the countless “invincible” uninsured people that later regretted their decision because of accident or disease that does not spare anyone due to attitude. I will also reflect on the provisions outlined in the ACA that allow these people to never experience the abuse of insurance companies to offer them inferior health insurance plans which would not offer the protections that they might later need (I can already predict that Mr. Wondra will flinch at the idea of my assumptions as to what an individual may or may not need for health insurance, but I insist that this is there is some basic level of truth to this: the concept of the mini-med policy was reprehensible and deceitful to its customers).

        Mr. Wondra’s only real argument is that the market would better serve the people than the “government control.” This point is almost vapid because it does in no way acknowledge the truth: all of our markets are regulated. The only argument is where is the line that each person draws as to where that regulation must end and the market begins? Does an online marketplace with dozens to hundreds of health insurance options (depending on your location) not qualify as a market? Note, Mr. Wondra, that this is a rhetorical question. I have a fairly good idea what your answer is.

        Mr. Wondra insists that I should be up-front about my refusal to consider alternatives but makes no effort to educate me on what those might be. All I have received is a refutation of claims with no follow-through. This is not a healthy debate – this is the petulance of a child. As I review the comments that Mr. Wondra makes in other debates online, I begin to wonder if I have not wasted my time by challenging a wall. I’m disappointed that he makes no attempt to cover my other points.

      • FriendlyGoat

        Unless you have lived through the nightmare of buying personal health insurance (so you can be self-employed) and then having your insurance company try every way in the world to rescind your coverage when your wife has a heart attack, you’re just another Republican blowing smoke. I’ve been there, and know for a fact that your blind love of the “market” indicates you are completely clueless about reality before ACA.

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