qotd: Facts disappoint both sides of the reform debate

Kaiser Family Foundation
June 19, 2014
Survey of Non-Group Health Insurance Enrollees
By Liz Hamel, Mira Rao, Larry Levitt, Gary Claxton, Cynthia Cox, Karen
Pollitz and Mollyann Brodie

The Kaiser Family Foundation Survey of Non-Group Health Insurance
Enrollees is the first in a series of surveys taking a closer look at
the entire non-group market. This first survey was conducted from early
April to early May 2014, after the close of the first ACA open
enrollment period. It reports the views and experience of all non-group
enrollees, including those with coverage obtained both inside and
outside the Exchanges, and those who were uninsured prior to the ACA as
well as those who had a previous source of coverage (non-group or
otherwise).

* The ACA motivated many non-group enrollees to get coverage, and
nearly six in ten Exchange enrollees were previously uninsured

* Enrollees in ACA-compliant plans report somewhat worse health than
those in pre-ACA plans

* Majority gives positive ratings to their new insurance plans and says
they are a good value, though four in ten find it difficult to afford
their monthly premium

* Among plan switchers, as many report paying less as paying more for
their new plans, but survey shows some signs of a trend toward narrower
provider networks

* Plan switchers are less likely to be satisfied with plan costs, maybe
because half of them report having their previous plan cancelled

* Half got help with enrollment; most say the shopping process was
easy, but a third say it was difficult to set up a Marketplace account

* In the non-group market, those most likely to feel they have
benefited from the ACA are people getting subsidies, those most likely
to feel negatively impacted are those who had their plans cancelled

As a whole, non-group enrollees are more likely than the public overall
to have a favorable view of the ACA – they are roughly evenly split
between positive and negative views (47 percent favorable, 43 percent
unfavorable), while views among 18-64 year-olds nationally are more
negative than positive (38 percent favorable, 46 percent unfavorable1.
Like it is nationally, opinion of the ACA among non-group enrollees is
strongly divided along party lines. About equal shares of non-group
enrollees feel their families have benefited (34 percent) and been
negatively affected (29 percent) by the ACA. However, these averages
mask substantial differences within the non-group market. Those who are
most likely to feel they have benefited from the law are people
receiving government financial assistance for Exchange plan premiums (60
percent benefited), while those most likely to feel they have been
negatively affected by the law are people who experienced a plan
cancellation in the past year (57 percent negatively affected).

http://kff.org/private-insurance/report/survey-of-non-group-health-insurance-enrollees/

The Wall Street Journal
June 19, 2014
Does the Affordable Care Act Cover the Uninsured?
By Drew Altman

Among the facts: 57% of those who bought coverage from the new
marketplaces during the first ACA open-enrollment period were previously
uninsured, and seven out of 10 of them had been uninsured for two years
or more.

The number of uninsured people covered through the exchanges is far
higher than critics of the ACA have suggested. On the other hand, the
number is probably a little lower than supporters of the health-care law
would like. As is typical in the highly polarized debate about the ACA,
the facts are not what either side would want them to be.

http://blogs.wsj.com/washwire/2014/06/19/does-the-affordable-care-act-cover-the-uninsured/

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Comment by Don McCanne

It is ironic that we have a health reform program that satisfies neither
proponents nor opponents. On the question of how effective has the
Affordable Care Act been in insuring those who were previously
uninsured, supporters are concerned that it was not enough and critics
are disappointed to see that more people became insured under the
program than had been insured under prior plans (since that refutes
their argument that the exchanges are ineffective because it only
shifted previously insured individuals into the exchanges).

KFF's Drew Altman makes the point that "in the highly polarized debate
about the ACA, the facts are not what either side would want them to be."

So is this a balanced debate between two sides with legitimate views?
Opponents would like to see much of the Act repealed, but the few
recommendations they do have, they can't even agree on. Besides, most of
their recommendations would not repair the flaws in our health care
system, and some would make them worse.

Supporters at least want to see improvements in coverage, access and
affordability, not to mention quality, but they realize that ACA is
falling far short of goals (though they may not want to admit it) and
has actually had a negative impact in lowering the actuarial value of
plans - making health care less affordable for many by increasing
out-of-pocket costs - while also reducing access by paring down the
numbers of physicians and hospitals in the insurers' provider networks.

We can reject the views of those polarized against reform as not being
responsive to our overpriced and underperforming health care system.

Although we support the views of those who would repair the flaws, we
can reject the policies they have selected as being cruelly inadequate.
Those who really do want reform should join us in supporting single
payer - a model that would be truly universal, accessible, affordable,
and, properly designed, would improve the quality of health care in the
United States. In fact, many of the current opponents might consider
supporting a program that actually would work, especially if they see
that it would not increase overall spending. We should tell them about it.