Uninsured Rates Remain At Historic Lows Despite HHS Marketplace Revisions

HHS: Fewer Than Expected Will Enroll Via Exchanges In 2016, Thanks In Part To Increased Enrollment In Employer-Sponsored Insurance. On October 15, the Department of Health and Human Services (HHS) issued a press release outlining its projections for the number of Americans expected to enroll in health insurance plans via federal “marketplaces” through the end of 2016. According to HHS' latest estimate, between 9.4 and 11.4 million Americans will enroll through exchanges in 2016. This figure is far less than the 20 million sign-ups initially estimated by the Congressional Budget Office (CBO), but HHS cited the expansion of employer-sponsored insurance (ESI) and increased enrollment on the individual market as a main reason for the downward revision:

We project that in 2016 the yearend effectuated enrollment will be 9.4 to 11.4 million. 4 ASPE's analysis implies that most of the new Marketplace enrollment for 2016 is likely to come from the ranks of the uninsured, with more than three previously uninsured new enrollees for each one new enrollee who previously had off-Marketplace individual coverage.

[...]

We adjusted the CBO projections according to lessons learned over the past two years about enrollment through the Marketplaces and the most recent information available about trends in ESI coverage and in the individual market outside the Marketplaces. Specifically, we adjust CBO estimates downward based on employer surveys from Mercer and other industry sources, which suggest that shifts from ESI coverage and the off-Marketplace individual market into coverage through the Marketplaces will be smaller than CBO expected and that the remaining uninsured may be harder to reach than in previous years. [Department of Health And Human Services, 10/15/15]

Gallup: Uninsured Rate Drops To 11.4 Percent. According to the July 10 update to the Gallup-Healthways Well-Being Index, the percentage of American adults who are uninsured dropped from a peak of 18 percent in the fourth quarter of 2013 to just 11.4 percent in the second quarter of 2015 -- the lowest uninsured rate on record:

[Gallup, 7/10/15]

RAND: Largest Share Of Insurance Coverage Gains Came From Employer Plans. According to a report by health policy researchers at the RAND Corporation in the June 2015 edition of Health Affairs, the number of uninsured dropped from 42.7 million in late 2013 to 25.8 million in early 2015, with the largest share of coverage gains (9.6 million) coming from enrollment in employer-sponsored plans. [Health Affairs, June 2015, p1044-1048]

Wall Street Journal Uses HHS Revisions To Call For Republican Alternatives To Obamacare

WSJ: “ObamaCare's Image Of Invincibility Is ... A Political Illusion.” On October 25, The Wall Street Journal's editorial board hyped the 2016 enrollment estimate from HHS to claim that the numbers show that the health care law will need to be readdressed in 2017 and that insurance exchanges “won't survive actuarially unless” more people between the ages of 18 and 34 enroll. The Journal concluded by promoting Republican candidate Jeb Bush's health reform proposal as a viable alternative:

ObamaCare's image of invincibility is increasingly being exposed as a political illusion, at least for those with permission to be honest about the evidence. Witness the heretofore unknown phenomenon of a “free” entitlement that its beneficiaries can't afford or don't want.

This month the Health and Human Services Department dramatically discounted its internal estimate of how many people will join the state insurance exchanges in 2016. There are about 9.1 million enrollees today, and the consensus estimate -- by the Congressional Budget Office, the Medicare actuary and independent analysts like Rand Corp. -- was that participation would surge to some 20 million. But HHS now expects enrollment to grow to between merely 9.4 million and 11.4 million.

Recruitment for 2015 is roughly 70% of the original projection, but ObamaCare will be running at less than half its goal in 2016. HHS believes some 19 million Americans earn too much for Medicaid but qualify for ObamaCare subsidies and haven't signed up. Some 8.5 million of that 19 million purchase off-exchange private coverage with their own money, while the other 10.5 million are still uninsured. In other words, for every person who's allowed to join and has, two people haven't.

Among this population of the uninsured, HHS reports that half are between the ages of 18 and 34 and nearly two-thirds are in excellent or very good health. The exchanges won't survive actuarially unless they attract this prime demographic: ObamaCare's individual mandate penalty and social-justice redistribution are supposed to force these low-cost consumers to buy overpriced policies to cross-subsidize everybody else.

[...]

ObamaCare will almost inevitably be reopened in 2017, whoever wins the election. The good news is the emerging consensus among Republican candidates about a credible, pragmatic and optimistic alternative. Jeb Bush was the latest to release a plan two weeks ago--and this is a debate that has always deserved to be litigated at the presidential level to create a mandate for reform.

The basic approach is to deregulate insurance and medical practice while replacing ObamaCare's complex subsidy schedule with a refundable tax credit for individuals who lack job-based coverage. [The Wall Street Journal, 10/25/15]

WSJ Made Multiple Factual Errors To Reach Its Conclusion

Charles Gaba: Wall Street Journal Made “Glaring Errors.” According to an October 25 rebuttal by Charles Gaba, The Wall Street Journal's editorial on Obamacare contained multiple errors, including the false claim that for “every person who's allowed to join and has, two people haven't” (emphasis original):

The Wall Street Journal has made a fundamental error here. They don't seem to understand that& most of the 8.5 million people enrolled in off-exchange private policies are part of the same risk pool as the exchange-based enrollees. Setting aside a couple million “transitional” and “grandfathered” policy enrollees, the other 5-6 million (guestimate) are treated just like exchange-based enrollees for purposes of risk pools. The only reason most of those folks haven't signed up via the exchanges is because they make more than 400% FPL and therefore don't qualify for federal tax credits. [ACASignups.net, 10/25/15]

WSJ Praised Jeb Bush's Plan, Which Hurts Oldest And Poorest, Will Disrupt Healthcare For Millions

Oldest And Poorest Stand To Lose The Most Under Bush's Plan. According to the 2017 Project's executive summary of its plan -- “A Winning Alternative to Obamacare” -- the proposal the Bush plan is based off of -- Republican tax subsidy plans would reduce assistance currently granted to low-income individuals and older working-age Americans under the Affordable Care Act, while creating new tax breaks for high-income individuals:

[2017 Project, A Winning Alternative to Obamacare, accessed 10/13/15]

The Hill: Bush Admits Plan “Would Disrupt Coverage” For Millions. According to an October 13 article in The Hill, Jeb Bush's health care proposal might be less expensive for the government than the Affordable Care Act, but the savings would come at the expense of the poor and “disrupt coverage” for millions currently receiving health care subsidies:

The GOP presidential candidate would provide tax credits to help people pay for coverage. But instead of the comprehensive coverage they can get from ObamaCare, Bush's plan would allow them to buy cheaper plans that offer protection in the event of “high-cost medical events.”

Bush, who criticized ObamaCare for driving up costs, is touting his proposals as a more cost-conscious and responsible way of providing healthcare. Critics are likely to argue it will also cut off benefits, particularly for the poor.

[...]

Bush acknowledges his plan would disrupt coverage for people who currently have plans through ObamaCare. The Obama administration says about 17 million people have insurance either through the Affordable Care Act's marketplaces, its expansion of Medicaid or by staying on a parent's plan until age 26. [The Hill, 10/13/15]