If you’ve been following the debate over the Affordable Care Act, you know that the White House is claiming that 4 million people have recently gained health insurance through the law by signing up for Medicaid. At two-thirds of the law’s newly insured so far, this 4 million number is a pretty big deal and has been used by plenty of defenders of the law.
As the Washington Post’s Glenn Kessler explains today, he too has used the number (to be precise, 3.9 million) to fact-check some GOP claims. However, after reading an analysis by Sean Trende casting serious doubt about the 3.9 million figure, he realized that there might be more to the story than he originally thought. That leads us to today’s piece by Kessler. He writes:
This all started with a dense report issued on December 20 by the Center for Medicare and Medicaid Services, a unit of the Department of Health and Human Services. A CMS official walked us carefully through the numbers, and we also consulted with experts on Medicaid. . . .
Generally, reporters and administration officials have treated the 3.9 million as being entirely composed of people who ended up on Medicaid because of provisions in the law. . . .
But what these figures do not tell you is how many additional people have joined Medicaid because of the Affordable Care Act. No one really knows, though some have tried to tease out figures from the data that has been presented.
CMS says that information about the number of people added because of the Medicaid expansion will not be available until after the end of March, when states start sending their quarterly bills to the federal government for their 100 percent refund of people in the expansion pool. Determining how many people came out of the “woodwork”—the previously eligible who suddenly focused on health care options and thus joined Medicaid—will take even more analysis.
Essentially, then, it is ridiculous to suggest, as the @BarackObama tweet does, that the people who have selected a health plan in the exchanges are in anyway equivalent to the 3.9 to 4.2 million who were deemed eligible for Medicaid. . . .
We’re awarding Three Pinocchios to everyone, including The Fact Checker, who improperly used this number or left the wrong impression about it.
Now I wish Kessler would revisit his fact-checking of Jason Furman’s claim that the ACA will cut the deficit by more than the sequester because it reduces health-care-cost. I don’t contest that the sequester will have very little impact on the deficit, but I am stunned that Kessler awarded Furman’s claim just one wooden puppet. For one thing, as my colleague Robert Graboyes said to me when I sent him Kessler’s article the other day, “this question is akin to asking, “Which will have a greater impact in curing cancer – bloodletting by leeches or frantic dancing under a full moon?”
Moreover, I’m surprised that Kessler wasn’t more skeptical about the claim that the ACA would bring (and is bringing) the cost of health care down. If he is ever interested in looking again into the claim, I hope he will read a few of the articles explaining why this is not the case.
While he’s at it, he could also fact-check the claim that the slowdown in health-care-cost growth (no matter what caused it) can solve Medicare’s financing problems as we hear often these days. If he does, he should read Charles Blahous’s new paper on the issue. As Blahous explains, “such a suggestion primarily reflects an incomplete understanding of how current Medicare cost projections are done.” Actual Medicare costs, his study shows, are more likely to be higher than the trustees’ current projections than they are to be lower.
Now, there is no doubt that the mandate in the law will force some people who were previously eligible for Medicaid to come ”out of the woodwork” and enroll in Medicaid, and force some people to buy insurance on the exchanges (with or without subsidies). However, there were many other ways to achieve the goal of increasing coverage without dragging us all into this mess. Graboyes puts it the best:
The arguments that sold the ACA are collapsing one by one. The law won’t cut costs or the deficit. It won’t allow you to keep plans or doctors that you like. The law does disrupt labor markets, thereby contributing to the persistent unemployment. We don’t even know yet whether on net more Americans than before will have coverage after the dust settles. Ironically, we could have expanded coverage significantly using only the laws that were already on the books in 2010 – before the ACA passed. At that time, there were 10 to 12 million people eligible for Medicaid who were not enrolled. With a better enrollment strategy, they could have been covered without disrupting the lives and health of the other 300 million Americans.
Another massive government failure, in other words.