Judging Obamacare: A How-To Guide
A step-by-step list for separating facts from flacks.
by Patrick Reis and Clara Ritger
August 27, 2013
Source: National Journal
It's going to be a messaging war for the ages.
When some of the Affordable Care Act's most critical features go into effect Oct. 1, so too will a massive struggle between the law's advocates and allies, as supporters attempt to convince Americans that the law is helping them afford their insurance, while critics scramble to prove it's sending insurance premiums skyward.
But as politicians pontificate and flacks flack, health care analysts are growing exasperated with a debate that is rapidly filling with faulty logic and fuzzy math.
"You can make those numbers look like almost anything you want," said Caroline Pearson, vice president of the D.C.-based health care consulting firm Avalere Health. "It has been highly politicized topic."
So, amid the spin, how should everyday Americans judge Obamacare's success in controlling the cost of health insurance? Here's step-by-step advice from the experts.
1. Don't believe the hype.
The October kickoff will be followed by a flood of studies and press releases, most of which will cherry-pick data while claiming to render a "final judgment" on whether the law is making insurance more or less affordable.
But those should all be taken with a tablespoon of salt, as no single piece of evidence—nor even any single study—can provide a definitive answer, Pearson said.
"There's not really a good way to answer the question. There's no apples-to-apples comparison," she said. "Is one product being sold today to one group of people going to be more or less expensive than a totally different product sold later to a totally different group of people? There's no way to compare those two in a way that would be deemed fair."
Rather than banking on a single study, understanding the law's effects on insurance costs will require a sustained, broad look. And even then it will remain a matter of ongoing contention—as neither camp is showing any signs of giving ground.
"I don't think the proponents will ever admit it's a failure," said Devon Herrick, senior fellow at the National Center for Policy Analysis.
2. Forget your arithmetic, remember your calculus.
Unless there is a sudden and shocking break from the long-term trend, health insurance premiums will continue to rise after the law takes effect—but that by itself isn't an indictment of the law.
Instead of lowering costs absolutely, the law's immediate aim is to slow the rate at which they are increasing, moving the rate closer to the rate of inflation. And it's by that metric that the law's insurance costs effects should be judged, Pearson said.
Moving toward the pace of inflation would be a major improvement from the past decade. Average premiums for family coverage rose by 80 percent and single coverage by 74 percent, according to the Kaiser Family Foundation's survey about employer-sponsored insurance coverage.
Although the rate of growth has slowed in recent years, premiums are up nearly 5 percent from last year for single coverage and nearly 4 percent for families. The growth outpaces wage earnings and inflation, which rose 1.8 percent and 1.1 percent respectively.
3. Ditch the God complex.
Despite what the Beltway crowd would have you believe, Obamacare won't be the only factor driving insurance costs in the years to come. In many cases, it won't even be the most important one. Instead, economics, demographics, and technology will often be in the driver's seat.
Take, for example, a Kaiser study released last week that found that although premiums rose again in 2013, it was at a slower rate than was seen before the passage of the law. Obamacare backers were quick to credit the law, but the moderation in costs were at least partially driven by the Great Recession, Herrick said.
"As jobs became less stable, employers cut back on medical coverage first," he said. "As the economy improves, you'll see people who otherwise wouldn't go to the doctor starting to use the system."
Additionally, medical technology can also move the premium needle, Person said, noting that innovative new breakthroughs can improve health results while simultaneously increasing health costs.
And then there are the nation's demographics, which are propagating a price bump that no law could interrupt: The baby boomers are getting old, moving a mass generation into the age range where more—and more-expensive—medical care is needed.
4. Don't ignore "It depends."
Coverage under Obamacare is not consistent. The upfront cost depends on which plan you select—and how much you use health care will determine your total annual expense.
The health insurance exchange has four tiers: bronze, silver, gold, and platinum.
The bronze plan offers the lowest premiums but the least coverage once a worker reaches the deductible and insurance kicks in. On the bronze plan, the provider covers 60 percent of the cost of care and the worker is responsible for 40 percent. This is, of course, after the worker has paid full out-of-pocket costs to reach the deductible.
So, if a worker has a healthy and safe year, out-of-pocket costs will remain low. Combined with the bronze plan's lower premium, this is the most economical choice for those using Obamacare.
Silver, gold, and platinum plans raise premiums but also raise the level of responsibility for the provider to 70, 80, and 90 percent respectively, offering greater protection in expensive and unforeseen health emergencies.
In an ideal world, you'd be on the platinum plan the year you broke your leg and on the bronze plan every other normal and healthy year, giving you the most for your money. But the success of your insurance choice, like the success of Obamacare, is a gamble.
5. Remember Olive Garden ... then forget about it.
Horror stories and tales of triumph have been regular features of the Obamacare debate, and they will continue to be going forward.
Conservatives were crowing earlier this year when restaurant CEOs—including top brass at Olive Garden and Applebees—said their chains would shed jobs and cut back hours because of the law's regulations. And the law's backers have not hesitated to do cherry picking of their own, repeatedly pointing to hard-luck individuals who suffered under the old health care regime and are already better off under the new one.
But while such anecdotes matter tremendously to the people involved, they are—when taken alone—a terrible basis for evaluating a national law that is set to affect nearly every facet of the American economy.
Like nearly every other law, the Affordable Care Act will have its individual winners and losers, but when it comes time for judgment, it's the bigger picture that matters.
6. Patience, patience, and more patience.
Americans won't get their answers on Obamacare any time soon, experts say.
Indeed, the White House decided recently to wait a year to enforce employers' mandate to provide their employees health insurance, and the administration has turned back the clock on a key consumer protection: out-of-pocket expense caps.
Even after the law is implemented, its fate will be far from settled. For example, the efficacy of the state insurance exchanges—which Herrick called the biggest determining factor in the law's success—will be determined largely by how successful they are in persuading people to enroll, especially young, healthy adults.
But while the law is still in its nascent stages, the doomsayers and cheerleaders have not—and will not—wait to make their case.
"I think the challenge is that people want to have something to weigh in on," Pearson said, "and nothing has started yet."