The Line: Millions of people have lost their health insurance and their doctors because of the Affordable Care Act.
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last year, president obama gave ad creators a lot to talk about when his promise “if you like your health care plan, you can keep your health care plan” was clearly proven false. We had said years before that Obama couldn’t make that promise to everyone, but the claim made headlines when Americans received cancellation notices for individual Marketplace plans that no longer met the requirements of the law.
Critics of the law now say millions have lost their health insurance. but that is misleading. those individual market plans were discontinued, but policyholders were not denied coverage. And the question is, how many millions of insured Americans had their plans canceled and how does that compare to the millions of uninsured Americans who got coverage under the law.
There is evidence that many more have obtained coverage than those who have canceled their policies.
American Prosperity Conservatives have made canceled policies a theme in their advertising. In a series of ads, a soft-spoken woman says, “Millions of people have lost their health insurance. Millions of people can’t see their own doctors.” That ad, which aired in February and March, targets Democratic senators in three states: Sens. Mark Udall in Colorado, Mary Landrieu in Louisiana, and Mark Pryor in Arkansas. the announcement issued against Sen. Kay Hagan in North Carolina in November, and was also used to target some members of the house.
another afp ad addressed to landrieu, and issued in January, said that “millions of Americans have lost their medical care.”
It is true that insurance companies discontinued health plans covering millions of people who had purchased them directly rather than through an employer. That’s because those plans didn’t meet the coverage standards of the new law.
but those policyholders did not lose the ability to have insurance. in most cases, insurers offered them an alternative plan, although there were a few cases of companies abandoning the individual market altogether.
Whether offered an alternative or not, people can buy insurance in the federal and state marketplaces, or directly through an insurance broker or company. many were likely eligible for federal subsidies to help pay for insurance, resulting in better coverage and lower rates for some. but the specific plan they had was actually discontinued. (More than half of those with canceled policies are likely to be eligible for federal assistance, according to research from the urban institute, and about 80 percent of all who buy plans on the exchanges are expected to qualify for subsidies, according to the congressional budget office.)
How many individual market cancellations were there?
The most widely used figure is 4.7 million, according to Associated Press reports from last December. but there are reasons to doubt the accuracy of that figure. an analysis of a more recent survey by researchers at the urban institute puts the figure at around 2.6 million.
an ap story that was published in december. on February 26 he said that “at least 4.7 million Americans received cancellation notices” and gave state-by-state figures for the “number of policies scheduled to be canceled.”
But the news agency did not say exactly how it arrived at the other figures that were included in the 4.7 million total, making the reports impossible for outsiders to verify. in three states, the numbers appear to be inflated. The Washington state insurance commissioner, for example, has publicly stated that the AP’s figure of 290,000 discontinued policies in that state is “inaccurate.” In a press release on his official website, Insurance Commissioner Michael Kreidler said there were only 278,000 total in the individual market at the end of September. Recent reports from our fellow fact-checkers at politifact.com and the washington post show that the numbers were too high in florida and kentucky.
And now, new research also gives reason to think the interest rate estimate may be inflated.
In a March 3 posting on the website of health affairs magazine, two urban institute researchers analyzed the results of a national survey and said, “our results imply that approximately 2.6 million people would have reported that his plan would no longer be fulfilled.” offered for non-compliance with the aca”. and in this case the methodology is explained.
In December 2013, the urban institute’s quarterly health reform monitoring survey of adults ages 18-64 included this question: “Have you received a notice in the last few months from a health insurance company? health that said your policy was or will not be cancelled?” will no longer be offered at the end of 2013? and of the 522 people surveyed who were covered by non-group policies, 18.6 percent said yes, their old plan would no longer be offered because it didn’t meet new coverage standards that went into effect in January. 1.
And if 14 million people were covered by non-group policies nationwide (as indicated by the US Centers for Disease Control and Prevention’s National Health Information Survey), that That percentage translates to 2.6 million discontinued non-group policies, the authors stated.
Of course, there is always a margin of statistical error in any random sample survey. lead author lisa clemans-cope told us in an email that statistically there is 95% certainty that the true percentage whose non-group policies were suspended is between 16.2% and 23.3% . that would put the number between 2.3 million and 3.3 million.
That range could be higher or lower depending on which number is used for the total of people who didn’t have group coverage in the first place. The Urban Institute authors cite a study published last year that found estimates of the total number of people covered by non-group policies to range from 9.55 million to 25.3 million. Thus, if 18.6 percent of non-group policyholders received notices that their policies were being canceled due to the new law, as the survey indicates, then the actual number whose plans were canceled could be as low as 1.8 million or as high as 4.7 million. (coincidentally, the same as the ap figure), depending on how many had such policies in the first place.
The authors, as noted, chose an estimate that fell in the middle of this range to arrive at their figure of 2.6 million discontinued policies. until and unless better evidence comes along, that’s the strongest figure available.
How many “millions” have been covered so far?
Early numbers on exchange and medicaid enrollment don’t tell us how many enrollees were previously uninsured, despite some claims by Democrats to the contrary. The Obama administration revealed on April 10 that 7.5 million had signed up for plans on the exchanges, but we don’t know how many previously had insurance. Medicaid rolls increased by more than 3 million through the end of February, the administration also said, a figure that would reflect both those newly eligible under the law and those previously eligible but now enrolling.
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But a survey funded by the Robert Wood Johnson Foundation and conducted by the Urban Institute indicates that many who signed up for the exchanges and Medicaid may be uninsured. found that 5.4 million previously uninsured people gained coverage between September and early March. exchanges launched in October. 1.
an april 8 report from the nonprofit rand corp. put the figure of new insured highest. Based on a national survey, Rand estimated that there was a net gain of 9.3 million “adults” insured in mid-March, when the survey was conducted. That includes Marketplace and Medicaid enrollment, as well as an increase in employer-based enrollment.
Neither of those figures include an estimated 3 million young adults who got coverage in 2010 and 2011, likely due to the provision in the law that allows them to stay on their parents’ policies.
rand also estimated that 700,000 people who previously had individual market plans now had no insurance. the survey did not determine whether people who recently became uninsured were due to cancellations or dropped coverage voluntarily.
It will be some time before more concrete coverage figures are available. Rand numbers are extrapolated from a survey, and one with considerable margins of error. the estimate of 9.3 million new policyholders has a margin of error of 3.5 million people, which means that the researchers have a high degree of confidence that the true figure would be between 5.8 million and 12.8 millions. and the estimate of 700,000 uninsured people who previously had individual market plans carries a margin of error of 900,000, putting the likely true number between zero and 1.6 million people.
Millions more are expected to get insurance under the law across the country in the coming years. The nonpartisan Congressional Budget Office estimates there will be 25 million fewer uninsured due to ACA as of 2016.
the afp announcement also states that “millions of people cannot see their own doctors”, but there is no evidence that all those who had suspended individual market policies ended up unable to keep their own doctors. Anecdotally, we know of some people who were able to keep the same doctor on a new insurance policy. but those are just a few individual stories. one of our guiding principles here is the saying, “the plural of anecdote is not data.”
It is true that using a smaller network of providers is one way insurers can lower premium costs, and there is evidence that insurers are doing this for exchange plans. As Deborah Chollet, a senior fellow at Mathematica Policy Research, an independent research firm, told us in December: “The narrow-net plans offered by some issuers are intended to (a) maximize bargaining power with providers by lowering their points. selling; and (b) therefore reduce premiums to attract consumers.”
Limited networks have been around for some time, as anyone with an hmo, ppo and the like can attest. no statistics are available to show whether the plans on the new exchanges have more or less tight networks than existed on the individual market previously. but again, insurers are certainly limiting their networks to price their plans competitively.
Karen Pollitz, a senior fellow at the Kaiser Family Foundation, told us, “Definitely (based on conversations with insurers and providers) insurers have decided to limit networks in some cases to price their health plans. more competitively.” He continued: “It is also definitely true that some providers have refused to participate in some of the new health insurance networks, demanding higher rates from some insurers in exchange for a promise to participate exclusively in their networks. … this is market competition at work, not entirely transparent unfortunately, so it’s not yet clear what the impact on patients will be.”
— lori robertson and brooks jackson