The Patient Protection and Affordable Care Act was signed into law four years ago Sunday, and contrary to its sponsors' hopes, the measure better known as Obamacare has grown less popular over time, not more. Trying to put the best possible spin on the anniversary, Health and Human Services Secretary Kathleen Sebelius offered "four big reasons to celebrate" in a blog post Friday.
Unfortunately, at least three of those reasons are, if not bogus, at least misleading. And I say this as someone who thinks the Affordable Care Act is a good thing (albeit a work in progress).
The first reason cited by Sebelius: "More than 5 million people have signed up for coverage through the health insurance marketplace." That's true, and the vast majority of those people have also followed through by paying their first premiums. But the implication is that the marketplace (the exchanges in each state where individuals can buy insurance) enabled 5 million uninsured Americans to gain coverage. And that's not true.
The exchanges run by the federal government, and several of those run by the states, don't track how many of the enrollees were previously uninsured, so it's impossible to say how many of the 5 million had lacked coverage. But research suggests that most had policies before; according to a survey by McKinsey & Co. consultancy, only 27% of those who signed up in February had been uninsured.
The second reason: "Private health insurance premiums are growing at the slowest rate in a decade and a half." Again, that's misleading. Healthcare spending has slowed noticeably in the wake of the recession, but I've yet to see any study crediting the Affordable Care Act with that change. The cost-control mechanisms in the act are largely aimed at Medicare, and they're expected to make their mark on the system gradually.
Meanwhile, the act led insurers to stop offering lower-cost policies that didn't meet a new set of coverage standards. Although the administration in effect waived those standards and urged insurers to reinstate the policies, tens of thousands of Americans had to switch to more comprehensive insurance policies that were significantly more expensive than their previous plans.
The third reason: "Today, most health plans have to cover recommended preventive services free of charge," including flu shots, blood pressure screenings and mammograms. But there is no such thing as free in healthcare. What Sebelius really means is that these services must be provided with no out-of-pocket costs; insurers still have to pay doctors and hospitals for delivering the care. As a consequence, the cost of those procedures has been built directly into premiums.
Some advocates of the change argue that preventive services save money in the long run by finding problems before they grow into much more expensive conditions. Some research, however, suggests that screenings may also lead to more conditions being discovered and treated for longer periods, increasing the amount of healthcare spending.
The final reason cited by Sebelius: "[The] Medicare program is stronger than ever." I won't quibble with that, other than to note that Medicare doctors and hospitals and the Medicare Advantage program were all targeted with cost-saving changes that have yet to be fully implemented.
There are plenty of good things to trumpet about the Affordable Care Act, as the consumer group Health Access pointed out in a report Friday. These include the insurance market reforms that help those with preexisting conditions obtain coverage they can afford, the measures to promote higher-quality care and the experiments with payment systems that give doctors a financial incentive to keep patients healthy rather than profiting from their maladies. The administration should focus on those benefits should the act have a fifth anniversary.
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