When it comes to the Affordable Care Act, you have two choices about what to believe. You can go with objective statistics from Gallup, a respected survey organization, which indicate that the law has increased the number of Americans with health insurance by more than 10 million.
Or you can go with self-interested partisanship from the likes of House Ways and Means Committee Chairman Paul Ryan (R-Wis.), who states that the law is "beyond repair" and backs that up with manifestly bogus and dishonest assertions.
Let's start with Gallup, which on Wednesday issued its latest quarterly measure of America's uninsured population. Gallup says the uninsured rate for adults fell in the fourth quarter of 2014 to 12.9%, down from 13.4% in the third quarter and significantly down from 17.1% a year ago. The results are drawn from "more than 43,000 interviews with U.S. adults from Oct. 1 to Dec. 30, 2014, as part of the Gallup-Healthways Well-Being Index," Gallup says.
The uninsured rate among those 16 to 64 has fallen to 15.5% from 20.8% during 2014, Gallup says. Since there are about 200 million Americans in that demographic, the figure implies that Obamacare brought new insurance to nearly 11 million Americans. And that doesn't include the further increases due from signups for 2015. (Gallup's estimate tracks others from the Commonwealth Fund, the Rand Corp. and elsewhere.)
In a nutshell, "the Affordable Care Act has accomplished one of its goals: increasing the percentage of Americans who have health insurance coverage," Gallup says. The firm also anticipates a surge in enrollments because the ACA's requirement that businesses with 100 or more employees provide health insurance to 70% of their workers kicked in on Jan. 1. Penalties for individuals going without health insurance are also higher this year.
For ideologues like Ryan, this all translates into a "fundamentally broken" law. In an op-ed in Wdnesday's USA Today (bad timing), Ryan writes, "Congress can't save Obamacare with a few tweaks."
Because the facts and figures don't support his conclusion, Ryan has no choice but to offer fabricated complaints. Right off the bat, he writes: "The law takes power away from patients and hands it to bureaucrats."
One has to wonder: What planet does he call home? Patients have had virtually no power under America's healthcare delivery system for decades; they've been manipulated by bureaucrats working for insurance carriers, who unilaterally have decided what services to cover, what claims to deny, and what pre-existing conditions disqualified applicants from any insurance at all. The ACA limited or eliminated those insurance company terms.
Ryan resurrects the misleading canard that "millions of Americans" received "cancellation notices" from their old insurers. He's cunning enough not to cite studies from sources such as the Urban Institute, which crunched the numbers nearly a year ago and found that 2.6 million policies were canceled because of noncompliance with the ACA -- but that more than half the policyholders were eligible for subsidized, low-cost replacement insurance. In other words, slightly more than 1 million individuals or families had their insurance canceled and had to pay the full premium to replace it. Most of them almost certainly did replace it, often with more comprehensive benefits.
"Obamacare lets bureaucrats decide what insurance plans must cover," Ryan writes. "And it adds a whole host of new taxes and fees that drive up the cost of care." Yes. The law dictates what insurance plans must cover; it mandates, in fact, that insurance actually offer value by meeting minimum benefit standards.
As for that "host of new taxes and fees," there's no evidence that they "drive up the cost of care"; instead, they cover the cost of bringing insurance to millions of Americans who haven't had affordable insurance, by providing them with substantial subsidies. The Department of Health and Human Services calculates that 87% of the enrollees who chose a health plan via the government's healthcare.gov exchange are eligible for subsidies. These are people, plainly, who don't figure in Ryan's estimate of the costs and benefits of Obamacare.
Finally, Ryan takes a swipe at the ACA's provision defining full-time workers--those who must be covered under the law's employer mandate, as those working 30 hours a week or more. Ryan's GOP House caucus will take up a proposal to raise the definition to 40 hours on Thursday.
As we reported in November, this change is nothing short of a full-bore attack on the working class. There are 10.2 million workers notching 30 to 34 hours a week, or 7.4% of the workforce; this is the group most vulnerable to being pared back to less than 30 hours a week, if their employers are intent on circumventing the law.
But there are more than 61 million Americans working exactly 40 hours -- 43.8% of all workers. It wouldn't take much to cut many of them to 39 hours or below, thus taking them out of the protection of the Affordable Care Act under the GOP-favored change. And of course all those people already working 30 to 39 hours a week--about 20 million more--would still be excluded from coverage.
Obviously, when Ryan and his GOP colleagues talk about "fixing" the ACA, they're using the term in the same sense one talks about "fixing" a cat. They're plotting a handout to employers, at their employees' expense.