Myth 1: Minimum Essential Benefits Provide Excessive Coverage To Male Buyers

The Las Vegas Review-Journal: “ACA-Compliant Plans Are Loaded With Many Services Most People Will Never Use.” A November 8 editorial claimed many of the essential benefits required of insurance plans under the Affordable Care Act are excessive and will not be used by those covered:

But lest anyone think Obamacare is doing just fine here in Nevada, plenty of evidence to the contrary has come out in the past week, much of it in two reports from the Review-Journal's Jennifer Robison. On Sunday, Ms. Robison noted that new, ACA-compliant plans are loaded with many services most people will never use -- such as maternity care for a healthy, single, 20-something male. Such add-ons pump up the cost of premiums and also serve to encourage young, healthy people to pay the penalty tax for not having ACA-compliant insurance, rather than buy coverage larded with costs for benefits they'll never need. [Las Vegas Review-Journal, 11/8/13]

REALITY: Maternity Care For Men Protects Women And Spreads Financial Burdens More Evenly

Los Angeles Times: “Society Has A Vested Interest In Healthy Babies And Mothers.” According to the LA Times, unhealthy babies and mothers raise costs on the rest of society and waste public resources unnecessarily, which would affect men:

Society has a vested interest in healthy babies and mothers. And that's all society, because unhealthy babies and mothers impose a cost on everybody -- in the expense of caring for them as wards of the public, and in the waste of social resources that comes from children unable to reach their full potential as members of society because of injuries or illnesses caused by poor prenatal and postnatal health.

Child mortality rates are among the most important indicators of a nation's overall health profile, and the U.S. rate stinks compared with the rest of the industrialized world's -- at 7 deaths of children under age 5 per 1,000 live births, it's worse than Israel's, South Korea's, Japan's and every Western European nation's. That's why maternity and newborn care and pediatric services are among the 10 health benefits that Obamacare requires  to be part of every health plan.

Some of these benefits are so important, they're required to be among the free benefits of catastrophic health plans that may be sold to individuals under the age of 30. They include anemia screening for pregnant women and folic acid supplements for women of childbearing age. [Los Angeles Times, 11/1/13 emphasis original]

Los Angeles Times: Universal Maternity Coverage Balances Costs Between Men And Women. According to the LA Times, “the principal reason” women's premiums cost so much more than men's was due to the cost of maternity care, but with the Affordable Care Act, premiums are more balanced due to the mandate that every health plan must provide maternity care:

Up to now -- before Obamacare's rules kick in Jan. 1 -- only 12% of policies in the individual insurance market offered maternity coverage. Those that offered the coverage often did so as separate riders imposing huge deductibles for maternity care alone -- $5,000 for maternity services, according to a 2010 survey by the House Committee on Energy and Commerce, and limits on benefits of only a few thousand dollars. The cost of maternity and newborn care is the principal reason that, pre-Obamacare, women were systematically charged more for health insurance than men.

Because insurers pitched maternity coverage in the indivdual market only to buyers of chilbearing age, the premiums were high and they still made almost no money on them. One company internal memo reviewed by the committee stated that its loss on maternity riders came to 90% of income, a money-losing ratio," the memo said.

But that's what happens when you sell an insurance benefit to a narrowly defined market. Without the cross-subsidies inherent in a large pool of insured people, no single coverage is affordable to those who specifically need it. [Los Angeles Times, 11/1/13]

Washington Post: Until The ACA Was Passed, Pregnancy Was Considered A Pre-Existing Condition. According to The Washington Post, women who suddenly became pregnant and found that their insurance didn't cover pregnancy were often stuck because other insurance companies often considered pregnancy a pre-existing condition:

Up until now, many policies on the private market did not cover maternity care as a standard benefit. Women who unexpectedly became pregnant would find, to their surprise, they weren't covered for those services. In some cases, when they tried to switch, their insurance company would treat their pregnancy as a preexisting condition and not cover the cost.[The Washington Post, 10/31/13]

Washington Post: There Are Also Male-Only Services. According to The Washington Post, insurance plans are also required to cover some male-only services such as “one designed to check older men who have smoked for abdominal aortic aneurysms.” [The Washington Post, 10/31/13]

Myth 2: Young People Are Not Signing Up For Health Care

LVRJ: Obamacare Will Fail Due To A Lack Of Young Healthy Enrollees. According to the Las Vegas Review-Journal, young Americans are not willing to sign up for coverage under the ACA, which will lead to failure of the law:

And that leads to a big problem: For Obamacare to survive, more than anything, it needs millions of young, healthy people to sign up for insurance. Their premiums are supposed to offset the costs of older, less healthy people. Instead, as insurance broker Phil Randazzo told Ms. Robison, he is “really only seeing unhealthy people calling. We're not getting calls from the 31-year-old guy who just wants to buy health insurance.” [Las Vegas Review-Journal, 11/8/13]

REALITY: Young People Support The ACA And Their Enrollment Is Expected To Accelerate

HHS: “Half Of Single Young Adults Eligible For The Health Insurance Marketplace Could Get Coverage For $50 Or Less.” According to a press release by the Department of Health & Human Services, 46 percent of single young adults could access coverage through the exchanges for $50 or less:

A new report released today by the Department of Health and Human Services (HHS) shows that nearly half (46 percent) of single young adults who are uninsured and may be eligible for coverage in the Health Insurance Marketplace could get coverage for $50 or less per month.

[...]

Today's report examines data from the 34 Federally-facilitated and State Partnership Marketplaces and finds that out of 2.9 million single young adults ages 18 to 34 who may be eligible for coverage in the Marketplace, 1.3 million (46 percent) could purchase a bronze plan for $50 per month or less after tax credits.   In the 34 states, a total of 1.9 million young adults, representing nearly 7 in 10 (66 percent) of the potentially Marketplace-eligible uninsured ages 18 to 34, may be able to pay $100 or less for coverage in 2014. [Health and Human Services, 10/28/13]

Gallup: A Majority Of Young Americans Support The ACA. According to Gallup poll numbers, 51 percent of Americans aged 18 to 29 approve of the ACA:

Young adults aged 18 to 29 are more likely than middle-aged and older Americans to approve of the healthcare law. They are also the only age group more likely to approve than disapprove. Young adults are more likely to be uninsured than those who are older, and their willingness to get insurance is crucial to the law's success.

 

[Gallup, 10/23/13]

The Atlantic: Massachusetts' Health Care Reform Enrollment Started Slow, Accelerated Over Time. According to The Atlantic, Massachusetts' health care reform law, which the ACA is modeled after, had very slow initial enrollment, but saw enrollment levels spike as the penalty deadline approached:

“To my friends in the media, I have one message: please take a chill pill. You won't see 7 million enrollees for a while, and that's not failure, that's real world,” John McDonough, a professor at the Harvard School of Public Health who was deeply involved in the passage and implementation of Massachusetts' 2006 health reform law, wrote of the new Obamacare program in mid-October. In Massachusetts, getting people signed up “was a slow crawl, not a sprint.”

Data from the first full year of enrollment in the Commonwealth Care plans in Massachusetts shows that the number of people who purchased premium plans was minuscule at first, with a rate of increase of only 123 people in February 2007. That surged to 3,645 in April and then remained fairly steady all year, before spiking to 7,783 in the month before the penalty deadline for remaining uninsured kicked in.

[The Atlantic, 10/24/13]

Young Invincibles: Young People Are Likely To Put Off Signing Up Until The Last Minute. According to a blog post by the Young Invincibles -- a national organization representing young people -- young Americans are likely to delay enrollment in health care plans until close to the penalty deadline:

But backers of Obamacare -- and some experts on online consumer behavior -- say it's too soon to panic. Lots could change between now and March 31. Young people are likely to treat enrollment like a term paper -- they'll do it, but at the last minute. After all, according to one online insurance broker, that's what a fair number of their grandparents shopping online for Medicare plans do: wait until they're smack up against the deadline.

And e-brokers point out that shopping for insurance isn't like buying a book on Amazon or a plane ticket on Kayak. Sam Gibbs, president of eHealth Government Systems, said people take their time to understand insurance options and may visit a site repeatedly. It can be a “several weeks or up to a month process,” he said. “This is not a one and done type process.”

When Massachusetts did its own health reform, people typically had 18 interactions -- website visits, phone calls or email -- before they signed up. The big surge came in the last two months before the state's individual mandate kicked in. [Young Invincibles, 11/7/13]

CNN Money: In Massachusetts, Only 6 Percent Of Young People Remain Uninsured. According to CNN Money, despite a slow start to enrollment in Massachusetts Commonwealth Care plans, only 6 percent of young people are uninsured, down from 18 percent pre-reform:

The mandate, along with subsidies that make policies more affordable, has brought the Massachusetts uninsured rate down to 3%, the lowest in the country.

Now that firms with 11 or more workers are on the hook for insurance, small-business employees are less likely to go without. More low-income workers are covered. And the hard-to-persuade healthy 18-to-34 crowd has been brought into the fold: Only 6% of these “young invincibles” lack insurance today, according to the state's Center for Health Information and Analysis (CHIA), down from 18% pre-reform. [CNN Money, 6/4/13]

Myth 3: High Medicaid Enrollment Shows ACA Is Failing

LVRJ: ACA Enrollment Is Dominated By New Medicaid Recipients, Not Enough Private Insurance Customers. According to the Las Vegas Review-Journal, low-income applicants who qualify for Medicaid have been the majority of new ACA enrollees, while not enough private insurance buyers have signed up for coverage:

Furthermore, Ms. Robison reported Wednesday that the Nevada exchange, at nevadahealthlink.com, remains a major obstacle for potential enrollees, with brokers reporting frequent error codes, frozen pages and unwieldy questionnaires, if they can even get through online. Worse still, Mr. Randazzo said 80 percent of the calls he gets are from people eligible for the Medicaid expansion contained within Obamacare. Care for those Nevadans will be fully subsidized. Meanwhile, there aren't enough people buying into private insurance plans to subsidize the less healthy, the poor and the old. [Las Vegas Review-Journal, 11/8/13]

REALITY: Medicaid Enrollees Do Not Affect The Exchanges

Georgetown Center For Families And Children: “Successful Enrollment In Medicaid Will Not Undermine Enrollment In Exchanges.” According to the Center for Children and Family at Georgetown University, having low-income and sick patients on Medicaid may strengthen the private policies available on the exchanges:

Successful enrollment in Medicaid will NOT undermine enrollment in the exchanges - the opposite may be true in fact for reasons I will explain - but those enrolling in Medicaid ARE NOT ELIGIBLE FOR TAX CREDITS IN THE EXCHANGE. It is either one or the other - you can't be eligible for both. So no one who understands the law has been counting on these Medicaid enrollees to make the exchanges work.

In many ways, the insurance industry has always liked the fact that Medicaid tends to serve those with higher health care needs, thus taking expensive and sicker customers out of their risk pools so it is easier to make a profit.  From that perspective, Medicaid has always supported the private insurance system by serving those who can't afford private insurance or have higher health needs that a private insurance typically doesn't cover. [Center for Children and Family, 11/4/13, emphasis original]

USA Today: Early Medicaid Enrollment Is Testament To States' Ability To Educate And& Successfully Enroll Low-Income Americans. According to USA Today, high Medicaid enrollment shows states have become skilled at enrolling low-income individuals in programs that will benefit them:

To be sure, the rush to enroll in Medicaid indicates a strong demand for health care coverage. But the early spike is more a function of states' proven ability to find, educate and enroll low-income residents than an indication of an imbalance with healthier people who can afford insurance, as has been suggested.

It is important to note that early enrollment numbers reflect so-called “low hanging fruit,” said Matt Salo, director of the National Association of Medicaid Directors. Future increases are expected to be smaller. [USA Today, 11/6/13]