Obamacare News of the Day

The Transom: WE HAVE NO IDEA WHAT THE OBAMACARE NUMBERS REALLY ARE

• The long-teased RAND study of how many people have actually gained coverage under Obamacare is finally out, and the most startling thing about it is how massive a gap there is between their numbers and the Obama administration’s…
• The headline number you’ll hear today is 9.3 million gaining coverage – but that’s a net, because RAND also estimates that over five million lost coverage at the same time.  “Of the 40.7 million who were uninsured in 2013, 14.5 million gained coverage, but 5.2 million of the insured lost coverage, for a net gain in coverage of approximately 9.3 million.” That enrollment amounts to half the administration’s claim (which is over 7 million in the exchanges and over 11 million in Medicaid/CHIP). That discrepancy cannot possibly have been made up in the final three days of the enrollment surge the administration claims happened.
• Here’s another interesting note: of the increase in coverage, RAND finds that the largest cause was actually through the employer-based system, not the individual market or enrollment in Obamacare exchange plans. In other words, RAND finds that the exchanges were even less popular than we thought – and that it was employer-sponsored insurance (ESI) and the Medicaid expansion driving increased coverage. Rand finds enrollment in ESI increased by 8.2 million, and Medicaid by 5.9 million… but the bulk of those Medicaid patients were not newly eligible under Obamacare: “Medicaid enrollment increased by 5.9 million. New enrollees are primarily drawn from those who were uninsured in 2013, or those who had ‘other’ forms of insurance, including Medicare, retiree health insurance, and other government plans.
• Of those who were previously uninsured but are now insured, 3.6 million are now covered by Medicaid.” And for that much smaller portion that went to the exchanges, two thirds of them were already insured: “Our estimates suggest that only about one-third of new marketplace enrollees were previously uninsured. While this percentage seems low in absolute terms, it is slightly higher than an earlier figure reported by McKinsey & Company.”
• [RELATED] Forbes: RAND Comes Clean: Obamacare's Exchanges Enrolled Only 1.4 Million Previously Uninsured Individuals
  • RAND published the full report yesterday; it indicates that Obamacare’s exchanges only enrolled 1.4 million previously uninsured individuals. That 1.4 million is out of a total of 3.9 million exchange enrollees overall. That is to say, a little over a third of enrollees—36 percent—were previously uninsured. RAND’s figures don’t take into account the last few weeks of the Obamacare open enrollment period, and they contain a substantial margin of error, due to the study’s small sample size.
  • If you assume that 80 percent of signer-uppers will eventually pay their premiums, the true number of previously uninsured exchange enrollees is likely closer to 2 million. That’s far from what the Congressional Budget Office has projected; the CBO estimated that 80 to 90 percent of the first-year enrollees would come from the previously uninsured population. Instead, it appears to be more like 24 to 36 percent.
  • RAND finds that, overall, 9.3 million more U.S. residents have health insurance in 2014 relative to 2013. That figure has a margin of error of 3.5 million. But that’s not the interesting part. The interesting part is that 8.2 million of that comes from growth in employer-sponsored insurance. Labor force participation has been steadily declining, especially among younger individuals, which would seemingly make this result unlikely.
  • On the other hand, it’s theoretically possible that Obamacare’s individual and employer mandates have convinced millions of Americans to sign up for health insurance. A third possibility is that RAND’s survey is simply inaccurate. The authors note that “people may not report having Medicaid because their state uses a different name for the program or because they do not understand the true source of their insurance.” We just don’t know.
  • Notably, RAND finds that outside of employer-sponsored insurance, Obamacare’s impact on the uninsured has been minimal thus far—a net of 1.1 million between Medicaid (+5.9 million), the exchanges (+3.9 million), off-exchange individually-purchased insurance (-1.6 million), and other forms of insurance, such as coverage for federal employees and the military (-7.1 million).
• [RELATED] Wall Street Journal: Health-Care Law, Economy Boost Ranks of the Insured Employers Account for Much of the Increase

Ebony: When Doctors Slam The Doors on the Newly Insured…

• "I'm sorry, we are no longer accepting that kind of insurance. I apologize for the confusion; Dr. [insert name] is only willing to see existing patients at this time.” As a proud new beneficiary of the Affordable Health Care Act, I’d like to report that I am doctorless. Ninety-six. Ninety-six is the number of soul crushing rejections that greeted me as I attempted to find one. It’s the number of physicians whose secretaries feigned empathy while rehearsing the “I’m so sorry” line before curtly hanging up. You see, when the rush of the formerly uninsured came knocking, doctors in my New Jersey town began closing their doors and promptly telling insurance companies that they had no room for new patients.
• My shiny, never used Horizon health card is as effective as a dollar bill during the Great Depression. In fact, an expert tells CNN, “I think of (Obamacare) as giving everyone an ATM card in a town where there are no ATM machines.” According to a study 33% of doctors are NOT accepting Medicaid. Here in Jersey, one has a dismal 40 percent chance of finding a doctor who accepts Medicaid – the lowest in the country.
• [RELATED] National Review Online: Medicaid Patients Realize They Can't Find a Doctor
  • Writer Danielle Kimberly notes that doctors lament that Medicaid reimburses them far too little money for their treatment. However, doctors also lament that reimbursement takes way too long to arrive and that the paperwork and bureaucracy are far too frustrating.
  • A study from Merritt Hawkins released in February found that less than half the doctors in the nation’s largest cities take Medicaid patients; in 2009 it was above 55 percent.
  • The range varies widely from city to city and from specialty to specialty, but in some cities, it is nearly impossible to find a specialist who accepts Medicaid.  Only 7 percent of cardiologists in Minneapolis accept Medicaid; only 15 percent of dermatologists in Philadelphia; only 35 percent of obstetricians and gynecologists in Denver; only 28 percent of orthopedists in Seattle, and only 32 percent of family practitioners in New York City.

Kaiser Health News: Early Drug Claims Suggest Exchange Plan Enrollees Are Sicker Than Average

• Offering a first glimpse of the health care needs of Americans who bought coverage through federal and state marketplaces, an analysis of the first two months of claims data shows the new enrollees are more likely to use expensive specialty drugs to treat conditions like HIV/AIDS and hepatitis C than those with job-based insurance.
• The sample of claims data - considered a preliminary look at whether new enrollees are sicker-than-average  - also found that prescriptions for treating pain, seizures and depression are also proportionally higher in exchange plans, according to Express Scripts, one of the nation's largest pharmacy benefit management companies.

Fierce Government: As IRS customer service struggles, healthcare provisions loom

• The percentage of taxpayers who call the Internal Revenue Service's toll-free line and reach a customer service representative has sagged in recent years – just as the agency expects an upswing in confusion over the Affordable Care Act's tax provisions.
• In fiscal 2013, only 60.5 percent of people who called the IRS actually got through before hanging up. That's down from 70.1 percent in 2011 and a peak of nearly 90 percent in the mid-2000s.
• In the 2015 filing season, taxpayers who received subsidized insurance premiums through a healthcare exchange under the ACA will have to reconcile their subsidies with their actual incomes from the previous year. Those taxpayers receive subsidies based on their projected incomes. Once this year is over, they could end up owing the IRS money or be owed a refund, depending on how their actual income matches up to the projection.
• At the hearing, Koskinen said the IRS could receive millions of calls from taxpayers who received ACA subsidies and aren't sure how to file their tax returns properly. To help reduce the call volume, the agency plans to expand the information about the ACA available on its website, to answer common questions. "But inevitably, our experience is whenever there's a new provision, you get a significant number of calls asking about it," Koskinen said.