Economics, Health Care

Lots of sign-ups for Obamacare — and almost as many questions

Image Credit: shutterstock

Image Credit: shutterstock

Today President Obama announced that as of April 15, 8 million people have enrolled in the insurance exchanges set up by Obamacare. But that’s not all. According to a White House fact sheet:

  • 3 million young adults stayed on their parents plan,
  • 3 million more people had enrolled in Medicaid, with more on the way, and
  • 5 million people enrolled in plans outside the insurance exchanges.

The news was so good that even Republicans should, in the president’s words, admit that the Affordable Care Act is working.

Maybe not. What the administration has not told us is how many of those 19 million people already had coverage and lost it because of the Affordable Care Act. Or how many of them would have been covered by insurance this year and changed plans to get a big subsidy. Or how many of them thought they were going to get a better health plan but found out that their doctor is not in the network. Or how many of them spent more on insurance than they felt they could afford because there were no lower-cost alternatives. Or how many will find out that the taxpayer subsidy they are receiving will turn out to be too high—they might get a raise in a few months or work some overtime and will make a little too much money this year, or it might just be that the government’s computers didn’t get it right—and will have to repay the Treasury hundreds and perhaps thousands of dollars?

The president’s health plan is a hugely complicated enterprise. It has limped to the end of the first open enrollment period with numbers that look too good to be true.  If what we care about is getting insurance for people who otherwise would not be covered, then the numbers are too good to be true.

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9 thoughts on “Lots of sign-ups for Obamacare — and almost as many questions

  1. “…is working”

    …let’s wait for a few billing cycles to see how much of a hassle it is to get the bills paid before we call it “working”

  2. The “my doctor’s no longer in the network” problem cropped up long before Obama’s first term due to workers changing employers, employers changing plans, or doctors leaving the network (voluntarily or not). Therefore I don’t see that it’s fair to include that particular knock as if it were a special failing of Obamacare. Against the issue of people paying more than they used to, fairness requires acknowledging that others are paying less. I know a self-employed person, not eligible for subsidy, whose health care costs dropped by thousands because his family was formerly in a high-risk pool due to a pre-existing condition. (Let’s admit it: we all want to buy health insurance out of a pool where our family is the sickest one in the pool.)

    The two big questions in my mind are a) how many formerly uninsured people became insured, and b) did enough young people sign up to keep the plans both actuarially sound and affordable.

    • You will never know the answers until a new administration and congress is in place. Hopefully electronic records can’t be deleted as easily as the shredding machines in Little Rock.

    • To Michael P. Stein,

      OK then. I may be unhappy that OCare is taking more money from me, but that unhappiness is supposed to disappear when I am informed that most of the money is being given to others.

      To others with preexisting conditions. That is, others who were uninsured at the time they acquired their condition, but who want their medical bills paid anyway, while contributing only what they would have paid if they had been insured all along. Neat.

      • @Andrew_M_Garland – “OK then. I may be unhappy that OCare is taking more money from me, but that unhappiness is supposed to disappear when I am informed that most of the money is being given to others.”

        That’s how insurance always works. It takes money from a large number of people, and gives it to a smaller number of people.

        Your unhappiness will not, of course, disappear when you are told that the extra 5 or 10% you pay goes to allow others into your insurance pool. But I suspect a great deal of unhappiness would appear if you or someone in your family got cancer, and you were told that you were therefore being reassigned to the deep (high-risk) end of the pool and your premiums and out-of-pocket maximum were going up by 500% or so.

      • To Stein,

        You don’t understand how insurance works.

        Insurance collects together people with the same risk and charges them according to the payouts to those who suffer the risk events.

        People are not reassigned to higher premium pools because they incur the risk event.

        High-risk pools are socialism imposed by state legislatures, and now by our federal government. The govt wants healthy people to pay more than their risk would determine, to subsidize less healthy people, people who didn’t insure their risk until they became sick.

        OCare is a huge wealth transfer under the monopoly requirement that everyone buy a government defined and mandated plan. The political scheme was that people would blame their insurance company, not the government. Fortunately, many people see through this.

        Insurance companies aren’t angels. They have happily climbed in bed with government to make more money. Who should we blame? The insurance companies who are in business, or the government which is supposed to be fair to all groups, even the healthy groups?

        • @Andrew_M_Garland -

          “You don’t understand how insurance works. Insurance collects together people with the same risk and charges them according to the payouts to those who suffer the risk events. People are not reassigned to higher premium pools because they incur the risk event.”

          I really wish you had been around to explain that to my home insurance company about twelve years ago. Clearly they didn’t have your expertise in how insurance works. A tree in the yard came down and damaged the house and a car parked in the street. They first cancelled my policy, but then agreed to continue it – at a significantly higher premium. The tree was gone; it certainly wasn’t going to pose any further risk. If anything, our risk was lower going forward, not higher.

          Health insurance works even less like your theory (and I’m talking about pre-Obamacare). One problem is the definition of “same risk”. I work for a very large company. Our insurance is based on the average risk for the company, which is large enough to be a good match for the general working-age population. The only health question a new employee is asked is about smoking. I could take up skydiving or dressage (the sport that paralyzed Christopher Reeve). It wouldn’t affect my health insurance premium, even though I’m clearly at higher risk.

          Many years ago I worked for a very small company. One of the employees had lymphoma. She was forced out of the company; although it couldn’t be proved, she felt it was because of the effect she had on the company’s ability to get affordable insurance.

          When a person has an accident, it’s an event. When a person is diagnosed with metastasized cancer, amyotrophic lateral sclerosis, kidney disease, etc., it’s not an event – it’s a condition. Until and unless a cure is found, it is no longer a risk but a certainty that the person will need significant ongoing treatment, often for years.

          So next year, the insurance company is pretty well guaranteed to raise the premiums, as the expected cost of the sick person has risen. If the person works for a small company, not only does it suck to be them, but it also sucks to be a healthy employee of the same company – the group rate is probably going up.

  3. ‘The “my doctor’s no longer in the network” problem cropped up long before Obama’s first term due to workers changing employers, employers changing plans, or doctors leaving the network (voluntarily or not). Therefore I don’t see that it’s fair to include that particular knock as if it were a special failing of Obamacare. ‘

    It certainly is fair when the President and countless other Democrats repeatedly stated “If you like your doctor you can keep your doctor” and “If you like your plan you can keep your plan. Period.”

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