START OF 2018 OPEN ENROLLMENT PERIOD

Time: D H M S

House Republicans continue to obsess over the "Many Were Already Insured!!" non-story

Yesterday, while their fellow GOP colleagues were embarrassing themselves during a 3-hour grilling of Planned Parenthood President Cecile Richards, an entirely different GOP Congressional committee, the House Energy & Commerce Committee, was interrogating the heads of a half-dozen state-based exchanges, including witnesses from Connecticut, Oregon, Massachusetts, Hawaii, California and Minnesota:

As part of a renewed attack on the Affordable Care Act, House Republicans grilled Access Health CEO James Wadleigh and the heads of other state health insurance marketplaces Tuesday, saying they had wasted billions of taxpayer dollars on an effort that has raised health insurance deductibles and premiums.

“In many states, physicians aren’t taking any new Medicaid patients. Focusing on uninsured rates is not the only parameter,” Rep. Greg Walden, R-Ore., said.

Democrats on the House Energy and Commerce Committee, which held Tuesday’s hearing, defended the performance of the exchanges, saying they dramatically cut the number of uninsured and improved medical coverage.

“I hope we are not hoping that the state exchanges fail,” said Rep. Diana DeGette, D-Col.

Now, eagle-eyed readers may note that the "Republicans on the House Energy & Commerce Committee" are the same knuckleheads who issued a MASSIVE FAIL! "survey report" last May which claimed (falsely) that only 67% of ACA exchange enrollees were paying their monthly premiums. Of course, the correct number turned out to be around 88% (which rose slightly to around 90% this year as technical problems were resolved and the newly insured got used to the system).

Anyway, most of the questions at today's hearing seem to have focused on the usual suspects; some legitimate (technical problems, cost overruns, mismanagement of failed exchanges in Oregon, Nevada and Hawaii, etc) and some which are either nonsense or have nothing to do with the individual exchanges themselves (concerns about premium/deductible increases, etc).

However, there was one passage in this article which really caught my eye:

But Rep. Tim Murphy, R-Pa., said only about half of those enrolled in health coverage through Access Health CT were previously uninsured.

Murphy said there were expensive glitches that have prompted some states –including Hawaii and Minnesota -- to abandon attempts to run their own exchanges and switch to a federally run marketplace, but to hear the exchange chief’s testimony “it would appear everything is rainbows and unicorns.”

I'm going to ignore the next sentence, which claims that Minnesota has abandoned their exchange (to the best of my knowledge, while the Minnesota legislature has certainly discussed dropping MNsure and moving to HC.gov, they haven't actually done so and wouldn't be doing so until 2017 at this point anyway). It's the sentence immediately preceding it which I found noteworthy.

Long-time readers may recall that one of my very first true blog/analysis posts (ie, one which wasn't simply chronicling enrollment data) back in March 2014 was a rebuttal to Avik Roy's obsession with a report by the McKinsey Center regarding the percentage of ACA exchange enrollees who were newly insured, versus those who were previously insured already.

Read the entire piece if you'd like; the short version is that the McKinsey study gave their estimate (at the time) as about 27%...except that they also included off-exchange enrollees, and failed to give any guidance as to the ratio between on and off-exchange folks. Roy originally completely ignored the off-exchange market being included (which was kind of important, since off-exchange enrollees made up around half of the individual market at the time) and, when I called him on this, actually tried to claim that I was "overstating" the significance, which was nonsense.

In any event, I gave my own estimate that when open enrollment was over, around 50% of exchange-specific enrollees would probably be newly insured...and was vindicated awhile later by the Kaiser Family Foundation, which reported the final 2014 figure as around 57%.

A similar survey by the Commonwealth Fund this year found that the percentage had gone down a bit to 53% in 2015 (around 5.3 million out of 10 million total)...versus 57% of the 2014 enrollees (around 4 million out of 7.1 million total). In other words, the actual net number of newly enrolled is still 1.3 million higher than it was last year.

The point I'm making is that the fact that nearly half of exchange enrollees were already insured is NOT a revelation or a "gotcha". This is very well known and expected. I fail to see why Rep. Murphy thought that mentioning this to Mr. Wadleigh of the Connecticut exchange was supposed to be some sort of attack on the success of the exchange.

Guess what, Rep. Murphy? I was previously insured here in Michigan as well. My wife and I switched from a non-ACA compliant policy directly through Blue Cross...to an ACA compliant policy, via Healthcare.Gov...also through Blue Cross.

We did so for 2 reasons: First, because if I'm gonna run a website about the ACA exchanges, it kind of behooves me to use them; second, because having a variable income as I do, and being self-employed as I am, it makes sense to use the exchange in order to qualify for federal tax credits if my income drops below the 400% threshold.

Why on earth are you acting shocked or irritated that a substantial percent of the enrollees were already covered?

I have news for you: Let's suppose that, thanks to the ACA, the uninsured rate in America eventually drops down to virtually zero. Guess what? The following year, everyone who enrolles through the exchanges will (gasp) "already have been insured" prior to doing so (well, except for newborns, some brand-new citizens and so forth).

The point of the ACA is to help lower the uninsured rate as much as possible. That doesn't mean that 100% of that job has to be done via the exchanges (and obviously over half of that has been via Medicaid to date). Some of the reduction will be via employer-sponsored insurance. Some will be via the "sub26ers" staying on their parents plans due to the ACA provisions.

For the life of me I can't figure out why it matters a whit whether the exchanges (specifically) are enrolling a lot of previously-insured people. Is our money not as good as those who didn't have coverage before or something?

Let me put it this way: Let's suppose that in 2016, exchange enrollment goes up by a solid 5 million people (15 million effectuated enrollees in all). Let's further suppose that only 1 million of them (20%) are newly insured, and the other 4 million are switching from existing coverage of some sort.

Would it be better if more of them were uninsured to begin with? I suppose so...but so what? That's still another 1 million to subtract from the uninsured column, and another 4 million receiving ACA-compatible coverage, many/most of whom would presumably also receive some amount of financial help in the process, while also helping with the risk pool for the following year.

Why is this a bad thing again?