According to Jonathan Chait, Obamacare is going swimmingly. In New York Magazine, Chait rebukes recent Democratic defections on the ACA by picking four recent studies that show the ACA is “working extremely, even shockingly, well.” The problem with Chait’s piece is that in three out of four cases, he either misrepresents or overinterprets the studies he uses. When you look more closely at the data, it is not all clear that the ACA is working in the ways he suggests.The first study Chait cites is a report by the Urban Institute that finds, as have other studies, that the uninsured rate has come down. Despite the predictions of some ACA critics that the law would not seriously change the national uninsured rate, the Urban Institute reports that it has fallen by 30 percent. Here Chait is right on the facts but wrong on their meaning. More people are insured now than were before the ACA was passed—that much is undeniably true. But access to insurance does not mean that insurance actually buys you the care you need. At the same time the uninsured rate has dropped, Gallup recorded that more people are putting off doctors visits than at any time since the company started asking that question. High deductible plans are on the rise, which does trim some unnecessary consumption of medical care. But those plans also trim some of the necessary consumption. Furthermore, many Medicare and Medicaid enrollees are not getting the care that they require. When we have strong evidence that costs are making it impossible for people to actually seek care, pointing to “official uninsured rates” seems one big exercise in missing the point.The second study Chait cites is a report by the Centers of Medicare and Medicaid, showing that growth in national health care spending reached its lowest level this year since the government first started tracking it. This is the fifth successive year in which costs have fallen. The causes of the slowdown, and its staying power, are complex and have been debated across the pages of every major newspaper for over a year now. It is, however, clear that the rise of high deductible plans and the recession’s effect on spending have both helped cause the slowdown as much or more than anything the ACA has done. Nobody, apparently besides Chait, omits those factors when writing about the slowdown. After spending several inches of virtual ink mocking conservatives who said the slowdown might not last, Chait links to the official report from the Centers for Medicare and Medicaid—which itself says in its conclusion that historical evidence suggests the slowdown won’t last.The third study Chait points to is a very recent report from the Department of Health and Human services that shows hospital-acquired medical conditions have fallen by 17 percent since 2010. The fact that Chait cherry-picks this one datum as important evidence for the ACA’s success is opportunistic at best; when the law was being debated and passed, this was not offered as a metric by which the law would stand or fall. But even more importantly, he professes certainty where the government is more cautious. According to the report (notably not directly linked to by Chait’s piece), “Although the precise causes of the decline in patient harm are not fully understood, the increase in safety has occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events, spurred in part by Medicare payment incentives and catalyzed by the U.S. Department of Health and Human Services (HHS) Partnership for Patients initiative led by the Centers for Medicare & Medicaid Services (CMS).” That’s a more attenuated statement than the one Chait makes, chalking up the decline only “in part” to government efforts. And even though, as the Vox story Chait links to points out, the changed payment incentives and the Partnership for Patients are part of the ACA, neither of these features of the law are inseparable from the more controversial portions normally attacked by the law’s opponents.The fourth study Chait uses is a Kaiser Health News report showing that competition among insurers has helped keep premiums low in many states with marketplaces operated by the federal government. Here Chait is on most solid ground, as the massive premium hikes predicted by many opponents haven’t really materialized, especially in states with a higher degree of insurer competition. Some states will see increases as high as 11 or 16 percent for lowest-cost silver plan compared to last year, whereas in other places that plan will be cheaper than last year by 21-28 percent (but still higher than the national average). On average the rates are increasing between one and seven percent, according to KHN’s figures. Other estimates put the average increase for those who stay with the cheapest 2014 Silver Plan at 8.4 percent. For some even that 8.4 percent average could be better than what you might have gotten before the ACA, depending on a number of factors. But if the most you can say for Obamacare is that it has not made premiums spike through the roof, or brought average premium increases down slightly, that runs up against the fact that even at low growth premiums are still often quite burdensome to many Americans.Obamacare has not been the total horror many conservatives predicted, and against those low expectations Chait can urge practically any case he wants. But things on the ground in U.S. health care are in a bad way, and the ACA has not fundamentally changed that fact.
ACA AgonistesA Misleading Case for Obamacare
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