Sorry for the length, but I didn't have time to write a short blog.

Thursday, November 14, 2013

Health Care Hype Part 1: The numbers and the lies.

So I've been trying to sort out the whole Health Care thing from the massive hype. This is going to take at least three blogs maybe more to work through it.  Like or dislike the ACA, there is a boatload of information that is just wrong from both sides of the fence.

The website was a mess.  Obama's promise about keeping your own insurance was a lie, misleading, poorly stated...take your pick of terms. It was wrong.  Politicians lie.  From "I am not a crook" to "I did not have sex with that woman" to wondering where the WMDs in Iraq are, it is what politicians do. To quote H.L. Mencken, "A good politician is quite as unthinkable as an honest burglar."

So now what?

 Quite honestly, I didn't worry too much about it.  I've pretty much always had insurance through work, and now I buy it through my retirement plan, so I haven't gone on the website except to see what it looks like.

This is, as I understand it what is supposed to happen.  You can go on a state website if your state has one or on the national one which is not working if you don't .  From there you can look at insurance plans from bronze level to gold.  You can also call or find one of the places that will help you.  You can see plans from several companies and then pick the one you like.  Depending on your income, you may receive a tax subsidy to reduce the cost.  For some the cost will remain the same.  For some the cost of their new insurance will go up. But everyone who applies will get insurance and for millions it will be the first affordable insurance they will ever have. It has never been a secret that the insurance would not cost something.

The Medicaid expansion was designed to help millions who could not afford that cost.  The Supreme Court, however, ruled that states could choose to expand Medicaid.  Most thought that since it would actually save state money for the first three years and then still be 90 percent covered by the Federal government making Medicaid still cheaper than it is now, states would jump at the offer.  They didn't.  Again, take your pick of political view point. Some states honestly believe that Medicaid is going to create more poor or are just being obstructionists not caring about the poor.  Add to this that states have the option to create their own exchanges or rely on the Federal exchange. Again, many states decided not to create their own.

We also know that because of these options given to the states, the plan may struggle.  We also know that when it became apparent that many states were leaving it up to the Federal Government, the request for funds to expand the system was denied by Congressional appropriations. So the website, which was badly designed to begin with, then took the extra hit of having way more traffic than it was designed for. The question is will the exchange work? It is not government health care.  The insurance is through private insurance companies but has an oversight by government statute.  The other problem is that it is not just connected to insurance companies but must also be connected to the IRS, Social Security and other agencies for the subsidy portion to work.  The website becomes pretty complex.

Next came the cancellations.  Insurance policies are cancelled and changed every year. So to say every cancelation is a result of the ACA is wrong.  A number of the policies cancelled are junk policies but not all.  Some were not cancellations, but notification that the insurance would now be offered on the exchange.  Some of the cancellations are unscrupulous insurance companies trying to take advantage. And some were caused by the implementation of the ACA.

Predictions of the numbers are hard to come by because some states just don't know. The last figure I saw on cancellations was 3.5 million, but that was without the information from several states.  Another estimate was that the policies cancelled would be about five percent.  If we use the 3.5 million figures, then that means, given the projected population by the US Census Bureau of the US on November 10, 2013 which is 317,044,892, we are looking at 1.1 percent of the population losing their current insurance.  The five percent figure then means 15,852,245.  We begin to see how these numbers matter.

The other thing that I've found little in the way of numbers is how many of the plans cancelled are individual and how many are from the plans known as small group plans.  We also know that when the ACA was passed that most could actually keep their old plans.  The problem is that plans change and turn over at such a high rate that any plan that didn't meet the standard after the law was passed is not protected by the law.  So insurers continued selling bad plans for the past three years knowing they would have to replace them.  We can also look at the numbers from the above link which say about seven to eleven million will be cancelled.

Again we face the issue that the website was so poorly done, people who could get better plans and possibly cheaper cannot get through.  We also know that a "young, healthy people who had cheap plans with high deductibles, will end up paying more."  That's a fact that was not actually hidden.  It was just that many getting sticker shock never bothered to find out.

Those are some of the numbers which seem to change daily, but what of the politics of the law. That's up next.