Sally Pipes is (mostly) full of hooey.
2019 OPEN ENROLLMENT ENDS (most states)
Time: D H M S
Sally Pipes, according to her byline in Forbes, is the President of the Pacific Research Institute (another one of those "free market think tanks" along the lines of the American Enterprise Institute, Heritage Foundation, bla bla bla).
Today over at Forbes.com she posted an entry singing the praises of private insurance exchanges, as opposed to the eeeeeevil Obamacare exchanges.
I want to be clear about this up front: I have no problem with private insurance exchanges (at least no moreso than I have a problem with private, for-profit health insurance in general). Companies such as eHealth Insurance and it's brethren are perfectly fine, and I wish them well.
Having said that, Ms. Pipes has written an unbelievably disingenuous essay. Let's take a look, shall we?
The federal government is desperate for Americans to enroll in Obamacare’s exchanges. But most people have refused.
Well, for one thing, only about 28 million Americans (9% of the total U.S. population) even qualify to purchanse insurance via the ACA exchanges in the first place, so, y'know, that might have something to do with "most people" refusing, since you can't "refuse" to do something that you're not allowed to do anyway.
When the exchanges officially closed in February, the U.S. Treasury estimated that there were stillsome 6 million people who would have to pay the penalty established by Obamacare for going without insurance. So the White House re-opened the marketplaces for an extra six weeks to try to entice them.
Actually, it turns out that the estimate from the U.S. Treasury was not 6 million people, it was between 3-6 million households, and according to Larry Levitt of the Kaiser Family Founation, a) most of the children in these particular households likely are covered by CHIP/Medicaid and b) a good 20% likely qualified for an exemption from the non-coverage penalty, meaning that the actual number of people who likely would qualify for the tax filing season Special Enrollment Period is likely somewhere between 3.6 - 7.2 million people.
But...ok, 6 million is right in the middle of that range, so fair enough. Go on?
According to the latest government data, just 36,000 people have taken advantage of the extension.
Actually, no. According to the "latest government data" (admittedly, her piece was published several hours before the new CMS report was released), it's actually over 68,000 people as of 4/13 via HC.gov, and that doesn't include the 18,000 in California or an unknown number in the other 9 states (+DC). By my best estimate, the total should be around 111,000 nationally as of today (4/20), and will probably hit around 135,000 or so by the end of the SEP on 4/30.
Yes, this is far lower than 6 million or even the 600K - 1.2 million which I had originally spitballed, but it's a lot more than 36,000.
While these public exchanges stumble, private exchanges are thriving. They offer companies and patients access to high-quality care at reduced cost. Yet these private exchanges — like so much else that’s actually working in the private healthcare market — are at risk because of the heavy government hand of Obamacare.
Good for them. They're doing quite well, as I understand it. However, no, the "private healthcare market" is not in any way "at risk" because of Obamacare. Ask UnitedHealthcare, with their record profits just announced.
In fact, when HealthCare.gov was floundering in 2013, eHealth offered to lend its expertise to the federal government. “We are ready to help you get this program back on track promptly,” said CEO Gary Lauer in a letter to the president. The government demurred.
Good for him. As it happens, the HHS Dept., after an admittedly embarrasing launch a year and a half ago, was able to bring in the Code Red team and completely overhaul the federal exchange, while (most) of the state exchanges are vastly improved this year as well.
Private exchange enrollment has reached 6 million customers — twice last year’s figure. Consulting firm Accenture expects it to double again in 2016 and reach 40 million by 2018.
Yes, and again, good for them. Of course, when you read what Accenture actually SAID in the link you provided...
Health insurance exchanges, online marketplaces where consumers can easily compare plans and sign up for coverage, have gained momentum from the Affordable Care Act, and now they are taking off in the private exchange market, according to an analysis by management consulting and technology company Accenture.
Gee, imagine that! Accenture is crediting the ACA for causing private exchanges to take off! Funny how that works.
Also, funny thing about that 40 million figure: Most of that is expected to come from...
"mid-sized companies with between 100 and 2,500 employees, but Accenture expects the private exchange model to catch on with larger companies"
Again, just as only 9% of the U.S. population qualifies for private policies via the ACA exchanges, mid-sized and larger companies don't use the ACA exchanges at all (unless they drop coverage for their employees entirely and push them towards the exchange). The ACA's SHOP (small business) exchanges are only available for businesses with fewer than 50 employees, which makes this a rather apples/oranges comparison.
By contrast, the Congressional Budget Office has repeatedly reduced its enrollment projections for Obamacare.
In March 2011, the agency forecast that the law would enroll 34 million people by 2021. This January, the CBO updated that estimate to 27 million people by 2025. Two months later, it revised that number to 25 million.
Um...Sally? Actually, according to your own link, in March 2011 the CBO projected that the ACA exchanges would eventually enroll about 24 million people, plus another 17 million added to Medicaid/CHIP (and minus about 1 million from lost employer coverage and 6 million shifting from the off-exchange market to the exchange-based market). Yes, that would indeed have resulted in a net increase of about 34 million more people being enrolled.
Of course, the following summer, the Supreme Court ruled that the Medicaid expansion provision was up to the states, not the Federal Government, which meant that a good 5 million people or so were lopped out of the equation by GOP states which refused to expand the program. So, y'know, a good 5 million of that 9 million reduction was kind of the Republican Party's fault. However, you're partially correct that they've reduced their estimates by a few million regardless.
Oregon and Nevada had to abandon their state-built exchanges after receiving a combined total of nearly $400 million in federal grants. Oregon has since joined HealthCare.gov. The Obama administration is threatening to take over Hawaii’s struggling exchange, which has already cost north of $200 million in taxpayer money. New York, Rhode Island, and California are also struggling to finance their exchanges. Maryland has shut down its exchange.
Yes, that's all true, except that in case you haven't heard, Maryland replaced their exchange with a new one which kicked serious ass this year.
One administration official recently told a congressional hearing that the website was only 60 percent complete.That’s despite a $2 billion infusion of taxpayer money over the past five years.
Yes, $2 billion to enroll around 8.1 million (paying) customers, or around $250 apiece, which sounds like a lot of money until you realize that Marco Rubio and the Florida GOP's "free market" exchange has cost taxpayers 120 times as much per enrollee to date.
The Government Accountability Office reports that SHOP enrollment “has been significantly lower than expected.” In California, fewer than 2,000 businesses signed up. In Washington, just 72 firms have done so. The federal government, most likely to spare itself embarrassment, hasn’t even released sign-up data for its SHOP exchange, which is currently in operation in three dozen states.
I generally agree here, although the important number isn't how many businesses sign up but how many covered lives that means. I've confirmed 72,000 people across 9 states, and by my best estimate, the national total appears to be around 330,000 this year. Again, yes, this is well below expectations, but it's still a significant number.
Here's the punchline to the whole thing:
Earlier this year, eHealth announced plans to lay off 100 employees in the face of competition from the taxpayer-financed Obamacare exchanges. The CEO cited “lower membership than we expected in our individual and family health insurance business.”
Hmmmm...but wait a minute! I thought that the "free enterprise" mindset liked competition! Make up your mind!
So let me get this straight: If the CBO overestimates how many people will enroll in the ACA exchanges, that's Obamacare's fault.
But if a private insurance exchange overestimates how many people will enroll in their exchange, that's...also Obamacare's fault.