2018 MIDTERM ELECTION

Time: D H M S

It's just as bad to ignore a problem as it is to exaggerate it.

Going into the fourth year of open enrollment, my work here at ACA Signups has started to fall into a seasonal pattern. During open enrollment itself, of course, it's all about the core mission of the site: Live-tracking the number of people who actually sign up for ACA exchange policies, and the related news items which accompany that. In the spring, it's all about dust settling and wrapping up: Plugging in the hard numbers, seeing how they compare with what I had projected and so on.

In the summer and fall, however, I'm on my second year of tracking the average (unsubsidized) rate increases people can expect for the following year.

I started doing this last year in response to a flurry of news headlines screaming about CRAZY-HIGH OBUMMERCARE RATE HIKES OMG!!!...most of which, when I actually crunched the numbers, turned out to be massively overblown or flat-out wrong. Rates increases ranged from as little as less than 1% (Maine and Indiana) to as high as 40% (Alaska and Minnesota)...but the overall, weighted approved rate hikes ended up being around 12-13% nationally. Not fantastic, but also not horrific. The effective average hikes (after people shopped around for a better deal), as I expected, ended up lower--around 8% unsubsidized, and just 4% for those receiving tax credit assistance.

This year, I knew that things would be worse...that at least some of those screaming headlines would indeed finally be accurate. I knew this for a few reasons:

  • The Risk Corridor Massacre not only helped wipe out a dozen Co-Ops and a handful of private carriers...it also left many of the smaller surviving carriers cash poor as a result. Even if it hadn't been cut off at the knees, the RC program was scheduled to shut down at the end of 2016 anyway.
  • The Reinsurance program was also scheduled to shut down at the end of 2016 regardless of how well it worked, guaranteeing a one-time rate hike based on this alone.
  • The already-announced pullout of UnitedHealthcare from dozens of states was a pretty obvious precursor to later announcements by Humana and Aetna

...and so on. In addition, regular readers know that I've been continuously frustrated with the lack of attention being paid to the impact of the rate hikes on unsubsidized individual market over the past three years--not just the couple million exchange enrollees who don't receive tax credits, but the additional 6-7 million who enroll in off-exchange policies and have to pay full price.

I also knew that most people wouldn't find out about these rate hikes until just before the 2017 Open Enrollment period started...which also just happens to be exactly 1 week before the most important Presidential election in my lifetime. This, of course, meant that anti-ACA Republicans would pounce all over the rate increase news.

Finally, I also knew damned well that no matter how ugly the (again, unsubsidized) rate hikes turned out to be, at least some Republicans would still exaggerate it yet further.

There's two ways I could have tried to address this: Either pretend the issue didn't exist...or face it head on and make sure that as many people as possible knew as early as possible just what was likely to be coming down the pike (and yes, it's "pike", not "pipe" FWIW). Not only would this help avoid sticker shock in October (surprise!!), but it would also hopefully mean that at least a few people would also take the time to understand not just the headline number, but also why those rates are increasing so much, who will actually be facing them and, more importantly, who WON'T be impacted by them (ie, 97% of the entire U.S. population).

So, I started the project, painstakingly crunching numbers and revising/updating them as new, more current data was releasd. As new states were plugged in, the national, weighted, unsubsidized average started in the high teens, then slowly crawled it's way up to 23%...24%...and finally stopped at around 25%. I cited my work, explained my methodology and made sure to include caveats, disclaimers and so on any time there's missing/questionable data or when a guesstimate was needed.

I've received high praise from across the political spectrum for this project, including some which make me queasy.

This has led to a handful of fellow left-leaning, ACA-supporting folks (but just a handful) to express some concern that in doing so, I've "given the GOP their talking point!" and that I might be "selling out" to the right wing, bla bla bla.

This is utter garbage. It was nonsense last winter when I heavily criticized Bernie Sanders' single payer plan (and was lambasted for it), and it's nonsense now. It's perfectly proper to stress the fact that 85% of marketplace enrollees are unlikely to see more than a nominal rate increase whatsoever. It's perfectly proper to remind people that shopping around can help reduce rates even further (with the potential tradeoff of not keeping the same doctors/hospitals in some cases). It's perfectly proper to urge those enrolled off-exchange to see whether they might, in fact, qualify for exchange-based tax credits this year after all. It's perfectly proper to note that the vast majority of the country won't be hit by these rates.

HOWEVER, it is not proper to ignore the 7-9 million people who will be hit with these increases either. It's a real problem which does need to be addressed, and pretending it doesn't exist doesn't do ACA supporters any favors.

In short: If a number is 25, saying it's 0 is just as innaccurate as claiming it's 50.

The ACA is mostly working, and the problems it faces are absolutely fixable...but the first step in solving any problem is recognizing there is one.