New Studies Indicate Problems with ObamaCare Enrollment Figures

April 18, 2014

While President Obama has declared victory, cheering the enrollment of 7.1 million in the health insurance exchanges and announcing that the debate on the repeal of ObamaCare is over, studies from the RAND Corporation and Express Scripts indicate otherwise, says the Fiscal Times.

Outside analysis of the success or failure of the Affordable Care Act (ACA) is essential because the Department of Health and Human Services (HHS) has no way to quantify the most basic of information about insurance enrollment. The HHS systems cannot even determine whether an individual has paid his premium -- and merely signing up for insurance, without paying a premium, does not mean that someone is insured.  Moreover, the systems do not collect demographic information -- age, health status, whether the person was previously insured, and the like. Without this information, it is not possible to assess the success of the law. If the health insurance sign-ups were by older and sicker Americans, premiums will have to rise significantly.

The RAND Corporation looked at the health insurance market in September 2013 (right before the exchanges were opened) and open-enrollment at the end of March.

  • According to the study, there was, in fact, a net increase of 9.3 million insured. However, the rest of the data does not present as rosy a picture as that described by President Obama.
  • A significant portion of the increase in the number of insured actually comes from increased Medicaid enrollment, not an increase in private insurance. Nearly 6 million people enrolled in Medicaid, and most were eligible for Medicaid prior to the health reform law. More than 8 million people enrolled in employer-provided health care.
  • In total, only 3.9 million people actually enrolled in insurance plans through the state or federal exchanges -- not 7.1 million.

Express Scripts, a pharmacy benefit manager, found that those enrolling in the exchanges tended to be sicker than previous risk pools. This means that premiums will have to rise even more than was expected.

  • Enrollees in the state and federal exchanges have a 47 percent higher use of specialty medications than enrollees in commercial plans.
  • The rate of HIV medications in exchange plans is four times higher than commercial plans, prescriptions are 35 percent higher and anti-seizure medication 27 percent higher.
  • Of those enrolled in an exchange plan, Express Scripts found that 43 percent of them already had Express Scripts coverage in 2013, and at least some of the rest could have had coverage from another pharmacy benefit manager.
  • If the RAND figures -- that only 3.9 million actually enrolled in exchange plans -- are right, then it could be that only 2.23 million of these customers were previously uninsured.

Source: Edward Morrissey, "Two New Studies Raise Red Flags on Obamacare," Fiscal Times, April 10, 2014.

 

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