Tuesday, June 17, 2014

Perception isn't Reality

By definition, “success” is a favorable or desired outcome. To determine if something is a success, one identifies a set of goals to achieve in order to reach this outcome. When it comes to Obamacare, then, what is the definition of success?

It all depends on what set of goals we use. This week Obamacare cheerleaders such as Enroll America and Sarah Kliff have been touting the “success” of the first open enrollment season.

Enroll America is hosting a National Conference under the headline State of Enrollment - Getting America Covered. The featured speaker, The Artist Formerly Known as Ms. Shecantbeserious, blamed the lack of help enrolling people on "states where state governments didn’t cooperate." She wrapped up her speech by saying that she would rather have a rocky rollout and 8 million signed up than a fully functional website and 4 million enrolled.

Kliff, the Vox.com Senior Editor and self-proclaimed health care wonk, (hint: she can't even understand her own EOB's) has a long post titled: Selling Obamacare - How the White House convinced 8 million Americans they could afford health insurance. She starts by using a 60 year old Pilates instructor whose insurance premiums before Obamacare would have been upwards of $900 per month. Instead of buying then she went uninsured. Now she has a plan with premiums at $359 after a subsidy. For this healthy woman who "only gets one or two colds a year" this is much higher than she had hoped and it has come with trade-offs. She's skipping a trip to Brazil to visit her niece and also putting off building a website to advertise her business.

So what's the big point? We have 8 million people covered. Obamacare is a huge success! Right. Right? Right?

Maybe we should take a history lesson back to 2009 when we were told about how great President Obama's health care plan was going to be. This is what Obama said in his weekly address as to what the goals of his health care law would be:

This week, I conveyed to Congress my belief that any health care reform must be built around fundamental reforms that lower costs, improve quality and coverage, and also protect consumer choice.  That means if you like the plan you have, you can keep it.  If you like the doctor you have, you can keep your doctor, too.  The only change you’ll see are falling costs as our reforms take hold.

In addition to these three fundamental changes, the CBO also projected in 2010 that we would have 14 million more people insured either through Medicaid or private markets.

Measuring the success of Obamacare is extremely important. It represents a massive change to 1/6 of our economy. The stakes are high, and so is the risk of failure. These are things that all but 34 Democrats in Congress either didn't care about or were just too busy to read the bill before passing it. They took the White House and the authors of PPACA at their word. That word called for success in the form of lower premiums, more choices, better benefits, and more people with insurance.

None of the above have met expectations. Costs continue to rise. Small businesses are leery of whether or not they can afford to provide insurance benefits going forward. “If you like your plan you can't keep it - period.” Narrow networks restrict physician and facility choice. Outrageous limits on out of pocket maximums of $6350 for single and $12,700 for families aren't providing security through better benefits. Strict limitations on plan design (ActuarialValue) are reducing benefit flexibility.

The only thing we have been told is the number of people who picked a plan and may have enrolled. The number they share is 8 million, yet when you look at the total - Medicaid, SCHIP, and Exchanges - the figure used is 12.8 million*. What we are not told is that little asterisk:

* Of the enrolled HHS has no idea how many were previously uninsured, were previously enrolled in Medicaid, lost lower premiums, lost better benefits, or were forced out of their current plans.

Instead we hear the few stories of “success.” It is these tiny threads that groups like Enroll America will cling to in order to prove their worth. They now are trying to push a new narrative to feel worthy of their cause. At this point it’s no longer about success. Perception isn't reality: that ship sailed long ago.

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