2018 MIDTERM ELECTION

Time: D H M S

FLASHBACK: 15 months later, Avik Roy *still* won't admit what a foolish thing this was to say

Hey, remember this from over a year ago???

Now, here's the thing: I'm not saying that Mr. Roy's 20% is wrong, or that McKinsey's 27% is wrong. Maybe they're correct. I've only documented about 10% of the QHPs as being off-exchange; perhaps it really is only 20 or 27% of the total. I'm just saying that there's too many unknowns for anyone to conclude that it is 20% or 27% for exchange QHPs either. It's still a big unknown.

Furthermore, I do appreciate him at least bothering to read my own analysis. He's a Big Established Expert and I'm just some web developer in Michigan. He's (from his Forbes bio) the Opinion Editor for Forbes, a Senior Fellow at the Manhattan Institute for Policy Research, and was a health care policy advisor to Mitt Romney...while I create websites for small businesses, often while wearing a bathrobe.

But that doesn't mean that he's right, either...and unless I'm missing something important here, nothing that he's said proves that he is.

Completely setting aside the fact that Avik Roy was proven to be flat-out wrong across the board on the "how many were previously uninsured?" issue shortly thereafter (it turned out to be 57% of ACA exchange enrollees in 2014 and is about 53% this year), Roy's entire premise at the time was based on the bizarre claim that off-exchange policy enrollments were minor:

@UriManor @charles_gaba Off-exchange enrollments don’t affect exchange risk pool; usually previously insured. Not a big number either way.

— Avik Roy (@Avik) March 19, 2014

.@charles_gaba @UriManor Read your blog post. You overstate impact of off-exchange #Obamacare enrollment. See update: http://t.co/DZqoW1FWOT

— Avik Roy (@Avik) March 25, 2014

Of course, that was nonsense then and remains nonsense now. At the time over 50% of individual insurance market enrollees did so directly via the insurance company, although a good chunk of those were "grandfathered" or "transitional" policies and therefore belonged to different risk pools. Even so, it was still a hell of a lot more than a rounding error or whatever...yet Roy shrugged it off as barely worth mentioning.

This year, of course, the numbers have flipped: Several million more off-exchange enrollees are now on-exchange, so the ratio is now something like 55% exchange-based, 45% off-exchange (give or take).

I'm reminded of my pissing match with Roy from last year because the very respected conservative, anti-ACA insurance analyst Robert Laszewski has a post over at Forbes about King v. Burwell today.

His main point isn't gonna make Republicans happy, of course; he points out all the ways in which the GOP's proposed "fixes" in the event that they win their court case would be a big ol' pile of hurt for everyone involved:

No one wants to go backwards and leave any sick person out in the cold. But a system that lets any sick person be covered and allows any healthy person to stay out of the system until they need coverage without having to pay any consequences is a prescription for a financial disaster and an unsustainable system.

While both the House and Senate plans would create a means for people to continue to be covered in the wake of any Supreme Court finding that ended the subsidies in the federally run states, what we so far know about these proposals is clearly unworkable in the market and would lead to very big and unfortunate unintended consequences.

Of course, this is exactly what lots of folks, including myself, have been saying for months now, but it takes on a lot more meaning when stated by, say, the American Academy of Actuaries or, in Laszewski's case, one of their own fellow conservatives.

However, on a personal level, this is the passage which jumped out at me:

Republicans might then, ironically, argue consumers shouldn’t worry because the Obamacare subsidies cap the cost a consumer would pay for subsidized coverage based upon their income—big rate increases won’t lead to higher consumer prices for those subsidized.

That would be true but what Republicans also need to appreciate is that about half of those who buy individual health insurance are in the Obamacare insurance exchanges and half of those who buy individual health insurance do so off-exchange—people who buy direct from their insurance company or through an insurance agent. That means there are about seven million people in the off exchange market in these 34 states that are not now eligible for subsidies.

Under Obamacare there is now just one individual health insurance market. Subsidies aside, a health insurance policy for a forty-year-old making 800% of the federal poverty level costs exactly the same price as for a forty-year-old living in the same place making 100% of the federal poverty level. I will suggest that many of these consumers making more than 400% of the poverty level are likely to be Republicans—early retirees and self-employed business owners. These off-exchange people would be hit by very large rate increases under Johnson’s plan beginning as soon as January 1, 2016 should the Court find for those trying to end the Obamacare subsidies.

Did you notice how casually and matter-of-factly he said this?

I wonder what his fellow conservative Forbes healthcare writer Avik Roy thinks of that.

(Ironically, if the King plaintiffs lose their case and ACA enrollment w/subsidies are allowed to continue unimpeded, Roy's original claim (that off-exchange enrollment numbers are tiny) will likely become true...by perhaps 2018 or so).