Moving the Goal Posts: Now it's "How many of the UNINSURED have paid???"

Hat Tip To: 
Ken Kelley

Oh for heaven's sake. Having grudgingly given up on the general "But how many have PAID????" argument (answer: around 85%, plus another 8% or so who will pay by the time they actually receive the bill or shortly after it's, you know, actually due), and having conceded some ground on the "But how many were UNINSURED???" argument (answer: At least 33% of the first 6 million, more likely a good 40% or more when the additional 1.1M+ are added in, and possibly even as high as 49% by some right-winger's own admission...see below), at least one Forbes writer openly opposed to the ACA is now moving onto the next tactic: Combining the remnants of these two arguments, Voltron-like, into a new talking point:

"OK, most people have paid, and a high percentage of the total may be newly insured after all...but how many of those who are newly insured have paid???"

That's right, this is where they're trying to move the goal posts.

I've tried to post the entire back 'n forth; it's a bit disjointed because it's all on Twitter and partly because I came in partway through the discussion (it was brought to my attention by Ken Kelly). Anyway, I think you can get the gist of the argument below:

Ken Kelly : 106/1013 * 22.5m = 2.4m est UI sign-ups. by Feb 1-5. McKinsey numbers.

Chris Conover: Right, McKinsey also said 53% paid, i.e., 1.3m PAID UI. Don't cherrypick!

Uri Manor: using that 53% unpaid number is the epitome of cherry-picking.

Chris Conover: Name another source that has broken out payment rate by insurance status

Charles Gaba: What we know is 85%+ paid of total seems right as of moment. Else is speculation.

Chris Conover: Right, a hard # you don't like from McKinsey is speculation.

Charles Gaba: Speculation because (at the least) it's 6 wks out of date; much has changed.

Chris Conover: Properly weighted, UI share of McKinsey=49%. Thus weighted average pay rate=71.4%

Chris Conover: Based on BCBSA data current average pay rate=80-85%. So assume insured pay rate

Charles Gaba: I stand by my last paid/unpaid post: 93% WILL have paid when dust settles & due.

Chris Conover: Any insurer who predicted that for their formerly UI members likely will lose $

Charles Gaba: If your concern is that they'll "have" to jack up rates, fine; we'll see.

Chris Conover: Wait ing2 see UR reaction when freight train of double-digit prem. increases hits

Charles Gaba: Considering that BCBSM jacked up my premium from $400 to $800 in under 2 years...between 2009 - 2011, I'm not sure I see your point.

Now, this is interesting for a couple of reasons. First, notice that they've (and yes, I'm using Mr. Conover as a proxy for the entire anti-ACA pundit class) finally concceded that the vast majority of exchange QHP enrollees have paid (or at least that they will have done so within the next month or so).

More interesting to me is that--if I'm understanding Mr. Conover correctly here; obviously Twitter can cause some confusion of meaning--he seems to also be conceding that the "previously uninsured" level of the 7.1M+ exchange QHPs to date is actually as high as 49% of the total. This is not only higher than the 27% figure that keeps being tossed around based on the now-infamous McKinsey study (from early eternity ago as far as enrollments are concerned, as it only counted about 3.6 million or so), but it's even higher than the "1/3" number that the RAND study implied (based on the first 6 million).

Hell, it's even higher than my own estimate (assuming that the RAND "1/3 of 6M" number is accurate). I originally had stated that I figured it was probably around 50/50, but if the RAND estimate is true (based on the first 6M), then I had it too high at the time. I figure that a good 2/3 of the 1.1M who have enrolled since the RAND study were uninsured at the time; if that's true, and if RAND's 1/3 is also true, then we get: 2M + (2/3 * 1.1M) = 2M + 733K = 2.73M / 7.1M = 38.5%.

Now, I'm not sure where Mr. Conover got his 49% from; I think that McKinsey may have come out with their own updated study. However, it doesn't really matter. The point is that even someone openly opposed to the law is now admitting that up to half of the 7.1M total was previously uninsured (49%), which is fine with me. It completely wipes out the GOP's own previous talking point, but whatever.

SO, the new argument seems to be that the only reason why the paid percent is so high overall is because of the Fine Upstanding Citizens who were already insured; they're apparently "propping up" the paid percent to make up for the Poor, Lazy Deadbeats who are too cheap to actually pay their bills. Or at least that's my interpretation of the argument; I'm sure he'd accuse me of twisting his words.

I'm actually willing to admit that there might be something to this argument. If you've never had to pay for insurance before and are new to the process, perhaps you are less likely to pay your premiums than if you've already been paying through the nose month after month for years. Who knows?

However, here's the thing: The insurance companies don't seem to think this is a problem, or at least not much of one. They've been doing interviews, issuing press releases and so forth crowing about how thrilled they are with the millions of new members they've added. Perhaps this is all just putting a good face on it, but if they thought that a bunch of deadbeats were a serious problem, don't you think they'd be saying so?

So, that cuts to the heart of the attack: After months of complaining that not enough enrollees were previously uninsured, he now seems to be complaining that too many of them were previously uninsured...and that this is a problem, because the ones who were uninsured before have a tendency not to pay, therefore forcing the insurance companies to jack up their rates next year to make up the difference, like retailers raising prices to offset shoplifters.

Now, this may prove to be an issue this fall. I doubt it, but there are so many moving parts here, who the hell knows? HOWEVER, as I concluded via Twitter, insurance premiums were ALREADY SKYROCKETING long BEFORE the exchanges opened.

I have personal proof of this. In 2009, my policy through BCBSM for my wife, son and I was around $450/month. By 2011 it was up to $800/month. For the same policy.

The ACA had been signed in March 2010, but almost none of the major provisions had gone into effect by that point; as far as I can tell, the insurance companies decided to jack up their rates as much as they could get away with before the major regulations went into effect.

So don't give me this crap about the insurance companies having no choice but to raise their rates because of the lazy moochers sponging off of them. They'll raise their rates for any reason they want if they think it'll increase their profit margin. That's the nature of corporations, to maximize profits by whatever means they can, period.

There's nothing even wrong with this. Expecting a private, profit-based corporation not to try and maximize its profits is like expecting a tiger not to kill antelope. That's what they do, it's in their nature.

Which is the whole reason for having an industry which is supposed to help people pay for medical care tightly regulated.