In the latest leg of their endless journey to find bad news about the Affordable Care Act, conservative analysts and websites have seized on some ambiguous figures to declare that enrollment is "plummeting," "shrinking," "sinking rapidly"--choose your headline.
The most charitable interpretation of this claim is that it's based on extreme cherry-picking. The most accurate interpretation is that it's wrong.
And the most important underlying points are that (1) some attrition is inevitable and normal, and (2) the most aggressive interpretation of the statistics places the attrition rate about where experts expected it to be--at somewhere in the 2-3% range per month.
That figure recognizes that the individual health insurance market, which is the segment addressed by the ACA exchanges, is extremely volatile, with a sizable proportion of people moving in and out every month. Here's how the assiduous statistics-tracker Charles Gaba recently described why people might have dropped their exchange plans after signing up:
"Maybe they got a job with benefits and didn't need the [plan] anymore. Maybe they got married to someone who was already covered. Maybe they moved out of the country. Maybe they turned 65 and moved over to Medicare. Maybe they fell on hard times and moved onto Medicaid. Maybe their spouse or child passed away. Maybe they passed away. Who the hell knows?"
For these people, he observes, the law is working exactly as planned, giving them "the peace of mind of decent healthcare coverage for however long they need it before they move onto some other coverage. For some this may only be a month or two; for others it may be years. This is a good thing." (Emphasis in the original.)
What about the evidence, though? The ur-source for it appears to be an article in the resolutely anti-Obamacare Investors Business Daily. The piece, which is based on figures from the large insurers Aetna and Cigna, was cited by, among others, Tucker Carlson's conservative Daily Caller.
The IBD piece says Aetna "had 720,000 people sign up" for ACA exchanges by May 20, according to an Aetna spokesman. IBD continues: "At the end of June, it had fewer than 600,000 paying customers. Aetna expects that to fall to 'just over 500,000' by the end of the year." IBD's math places the attrition rate at 30% (720,000 falling to 500,000).
But according to an earlier IBD piece--flagged by Gaba--Aetna actually had only 580,000 paid enrollees as of May 20. Exactly how many fewer than 600,000 paying customers did Aetna have at the end of June? IBD doesn't say. But a drop from 580,000 at the end of May to 500,000 at the end of the year works out to a decline of roughly 2% a month. "Plummeting"? Hardly.
In any event, IBD may be treating the Aetna figures as more concrete than Aetna does. During a July 29 conference call with securities analysts, the firm's CEO, Mark Bertolini, cautioned that because two-thirds of its individual enrollments came in April and May, the company doesn't have "a whole lot of experience" with the ACA segment--and it wouldn't have a good sense of its pattern and pricing until the end of September.
IBD also quotes Cigna CEO David Cordani saying on a conference call that "it expects its individual market customers, including more than 100,000 in the exchanges, to 'move from 300,000 down to 280,000 in that range.'"
But Cordani gave more detail than that. He explained that most of Cigna's individual customers were in states that allowed grandfathered health plans--those that didn't comply with Obamacare's 2014 standards--to remain temporarily in effect. The vast majority of those customers are expected to transition into ACA plans or out of the market. So Cordani wasn't actually making a specific prediction about Cigna's exchange enrollments, a subset of that larger total. But he did say that "we're not flagging a big trend down for the year."
Over the years, the anti-ACA crowd has moved from one dire prediction to another. As each freakout turns out to be unwarranted, they seamlessly and shamelessly tee up the next. This week, it's "plummeting" enrollments and frightful attrition. Since this picture is also askew, what will be the next freakout? Stay tuned; you know there will be something.
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