The 2016 Open Enrollment Period Starts Tonight - What Can We Expect This Time Around?

For the third time since the passage of the hotly contested Patient Protection and Affordable Care Act, better known to both its supporters and opposition as ObamaCare, the healthcare Marketplace will open for enrollment at midnight tonight.

So what can we expect from this round of open enrollment now that we have two years of federally mandated healthcare insurance reform experience tucked neatly under our belts?  For the sake of preserving the law along with the dignity of those Democrats and the President who forced ObamaCare on the nation, hopefully we will get much more than the law has yielded from the previous two open enrollment periods.


Where Do We Stand Going In to the 2016 Open Enrollment Period?

In a news brief issued by HHS Secretary Sylvia Burwell in mid-October, she painted a less than rosy picture of the forthcoming open enrollment period.

With just over 11.6 million people having initially enrolled one the healthcare Marketplace (formerly known as the healthcare exchanges) during the 2015 open enrollment period, Burwell projects that only 9.1 million of those will still be insured at the end of the year (effectuated enrollment).

As for the pool of 28 million uninsured who were eligible to participate on the healthcare Marketplace when it was first launched in October of 2013, using information provided in two separate reports recently released by HHS, it appears that it has been reduced by fewer the 1.9 million.  This is significantly less than the 10 million the uninsured pool was projected to have been reduced by in 2015, when the law was first past.


HSS Enrollment Projections for 2016

As previously stated, HHS Secretary Sylvia Burwell does not paint a very optimistic picture of healthcare Marketplace enrollment for the coming year.

Of the 9.1 million projects to still have the healthcare insurance plan they obtained through the healthcare Marketplace in 2015, Burwell projects that only 7.3 to 8.8 of those will re-enroll this coming open enrollment period.  Burwell does however expect overall healthcare Marketplace enrollment to increase to between 11 to 14.1 million at the sound of the closing bell on January 31^st.  In the end, Burwell stated that the 2016 effectuated enrollment is expected to be between 9.4 to 11.4 million.

On the low side, the projected effectuated enrollment for 2016 is a gain only .3 million over 2015 and on the high side the gain is 2.3 million.

Speaking just of the uninsured, Burwell projects that from the pool of 28 million uninsured who were eligible to participate on the healthcare Marketplace at the onset, between 2.8 and 3.9 million will gain coverage through the healthcare Marketplace this enrollment period.

What Can We Really Expect for 2016

First, what we can expect is that in 2016 there will be a greater loss of the 2015 participants than Burwell has expressed in her news brief, at least if you wish to believe her projection that between 2.8 and 3.9 million uninsured will gain coverage in 2016.  Let’s take a look.

If you reduce the 2016 projected effectuated enrollment of be between 9.4 to 11.4 million by both the high and low figure of uninsured Burwell projects will participated on the healthcare exchanges this open enrollment period, worst and best case re-enrollment figures are 5.5 and 8.6 million.  In contrast Burwell reports re-enrollment to be between 7.3 and 8.8 million, numbers I have yet to figure out how she arrived at.

Regardless, the simple math says that if we want to believe Burwell’s optimistic predictions of uninsured enrollment, as few as .5 million and as many as 3.6 million 2015 participants on the healthcare Marketplace cannot re-enroll in 2016 for the numbers to work.

However, re-enrollment may not actually be as bad as stated here as it is based on a very optimistic, some would even say (including myself) fantasy like, enrollment predictions of the uninsured.

I have no clue as to the how HHS derived their uninsured enrollment projections, I am sure that they have a really cool model some number cruncher built for them (the name Gruber comes to mind) and the number of considerations that must be taken in to account to derive this figure is far beyond my very limited expertise.  But one thing is for certain, for whatever reasons, HHS and the Obama Administration has to as yet ever project new enrollment correct. 

Had their past projections been on target, there would be roughly 10 million fewer uninsured in that starting pool of 28 million and we would be looking at reducing the uninsured pool by another 6 million this coming open enrollment period.  But when you consider that fewer than 1.9 million of the oldest and least healthy of the uninsured have so far enrolled through the healthcare Marketplace over the 9 months of the first two open enrollment periods, the likelihood of nearly doubling that figure over the next 3 months is about as likely as Republican’s dropping their push to repeal the law.


In the Mean Time, Premiums Are Expected to Rise Considerably

While consumers in a few states and regions will see a reduction in healthcare insurance premiums, the majority of healthcare Marketplace shoppers are once again going experience rate hikes, substantial rate hikes in far too many cases. 

The Obama Administration has been pretty quiet on the matter, they have basically used up all their excuses.  What they have suggested however, is that consumers shop around for an affordable plan.  This is much the same advice President Obama gave us last year when rates on the most popular bottom tier Silver plans were hit the hardest.  Essentially what the administration is suggestion is that we need to ignore what a plan might have to offer us and instead we just look for a price tag we can afford.  This is what healthcare insurance has become on the individual marketplace I guess.

Despite what the Obama’s talking heads tell us, this will be the third year straight of rate hikes more substantial than the individual marketplace would have experience prior to the passage of ObamaCare.  The administration likes to mislead the American people by making the comparison to the individual marketplace rate increases the two years leading up to the opening of the healthcare Marketplace while failing to disclose that the individual marketplace suffered the highest rate increases in history over that two year period solely due to insurers having to cover all the new mandates that went in to effect just months after ObamaCare was signed in to law.  No person on the individual marketplace between 2010 and 2013 was exempt, each and every one saw their premiums increase from 40% on up to 100% and in some cases even more.

Roughly 85% of those individuals who are purchasing healthcare plans through the healthcare Marketplace are receiving taxpayer funded subsidies to offset the high cost of their new found insurance plans.  At the same time, better than 85% of those who are participating on the healthcare Marketplace are doing so after transfers from the private marketplace.  It is an easy connection to make that the majority of those who are now receiving subsidies once were willing and able to pay for their own healthcare insurance in full and without the need or desire for government assistance.  Again, this is what healthcare insurance has become on the individual marketplace.


Bigger Penalties are Coming

Whether or not you can afford to purchase healthcare insurance on or off the healthcare Marketplace is irrelevant, if you do not have a qualified healthcare plan in 2016 expect big penalties coming your way.

If you do not have health insurance in 2016, here is what the Federal Government demands that you pay:

·         2.5% of your yearly household income (Only the amount of income above the tax filing threshold, about $10,150 for an individual in 2014, is used to calculate the penalty.) The maximum penalty is the national average premium for a Bronze plan.

OR

·         $695 per person ($347.50 per child under 18) The maximum penalty per family using this method is $2,085.

 
So it all starts again at midnight tonight.  I don’t suspect that there will be much media coverage nor will Secretary Burwell or the President be reaching out to give us any enrollment updates.  They have already done their best to play down enrollment and continue to pass off the Medicaid Expansion enrollment as the measurement of success of the individual mandate.

Time will tell but if I were a betting man, I’d put my money on things getting pretty contentious once the final 2016 enrollment number are in.

We must not forget that this $2.4 million “almost” Universal Healthcare plan by its own best projections would fail to ensure no less than 30 million Americans and as it turns out that number is likely to rise to 50 million.  Again, if I were a betting man, I would put my money on Republican’s making this a major issue for whoever wins the Democratic nomination and force them to not just defend this incomprehensible mess they have made of our healthcare insurance system but explain to the American people just exactly why they should continue to support this madness that remains as unpopular today with the majority as it did the day it was signed in to law.

Healthcare Exchange Enrollment Far Worse than Previously Reported

It has been just over two years since the opening of the healthcare Marketplace and yet we still do not know definitively how many people have purchased a healthcare plan through the state and federal healthcare exchanges.
After an abysmal turnout by the uninsured during the first open enrollment period, the Obama Administration completely locked down the Department of Health and Human Services (HHS) from releasing detailed enrollment data, particularly anything pertaining to the number of uninsured that purchased a qualified healthcare plan through the state and federal healthcare exchanges. 

The Obama Administration had three years and spent nearly $1 billion taxpayer dollars to enlightening us all on the wonders of ObamaCare.  And as the opening day neared it was the President himself who repeatedly touting what a great success the individual mandate was going to be in bringing affordable healthcare to the 28 million uninsured individual who qualified to participated on the healthcare Marketplace.  And yet, so few showed that the administration was embarrassed to make public the enrollment figure.

The first open enrollment period was supposed to be the biggie with the millions of individuals who had been denied access to healthcare insurance due to a pre-existing condition knocking down the doors to sign up, along with others who the administration claimed always wanted healthcare insurance but were simply priced out of the marketplace.  As it turns out, only a handful of those thought to be at the front of the line on opening day ever turned out during the inaugural 6 month long open enrollment period.  Best estimates at the time were that just over 1 million of the 8.1 million who purchased a healthcare plan through the exchanges came from the pool of 28 million uninsured.  The balance was made up of individuals who had their non-ACA compliant plans canceled and re-insured themselves through the exchanges.  The Obama Administration never put an official head count to the number of uninsured who purchased and maintained a healthcare plan during the open enrollment period and they liked it that way.

The second open enrollment period fared no better than the first and the Obama Administration remained just as tight lipped to the number of the nations uninsured that purchased a healthcare plan through the exchanges.  And while they made no mention of this failure, the administration was constantly patting itself on the back for its success in enrolling millions on to taxpayer funded Medicaid as a result of the program’s expansion.

At the close of the second open enrollment period, best estimates at the time were that as many as 4 million of the nations uninsured might now have obtained healthcare insurance through the exchanges.  However, as more information became available, that number slowly dwindled to as few as three million.  It should also be noted that at the time ObamaCare was passed in to law, the administrations original enrollment goal for the close of the second open enrollment period was to have insured 10 million of our nation’s uninsured through the state and federal healthcare exchanges.


Drilling Down on Enrollment

Two reports recently released by the HHS together have helped to shed new light on enrollment of the uninsured through the healthcare exchanges.   

First is the ASPE Date Point Report.  Released this past September, from this report we can see that HHS has adopted the figure of 15.3 million as the number of people they are claiming to have gained healthcare coverage since the beginning of open enrollment back in October of 2013.  I say adopted as this is not a figure generated by HHS but instead one provided through an independent survey conducted by Gallup-Healthway Well-Being. 

The 15.3 million figure reported by Gallup-Healthway and adopted by HHS is reflective of all who have gained some form of healthcare coverage, since open enrollment first began, regardless of source.  In other words, amongst the 15.3 million are all those who are now covered through the Medicaid Expansion; those who purchased a healthcare plan on the private marketplace; those who are now insured through their employer and of course those who obtained healthcare coverage through the state and federal exchanges.
 
Just to be sure we are clear, this 15.3 million enrollment figure includes the entire universe of people that have gained some form of healthcare coverage since open enrollment started.  Also, this third party generated figure, adopted by HHS, is not based on an actual count and there is nothing that leads us to believe that HHS has validated it in any way.

If it strikes you as odd that HHS does not use their own enrollment count, it should as they most certainly have the resources to do so.

Second we have the CMS MedicaidEnrollment Report.  CMS publishes Medicaid enrollment updates monthly, this particular report being the latest release and represent enrollment through July of this year.  In the report we find that CMS has reported a figure of 13.2 million individual have taken advantage of the Medicaid expansion through July of this year.  Unlike the previous report, Medicaid enrollment is an actual count compiled internally by CMS so they own this. 

We will use the Medicaid enrollment figure to help us determine enrollment through the healthcare exchanges but first I am going to take the liberty of bumping it up by 200,000 to make it more representative of what enrollment looked like in September thus matching the same time period of the previously discussed ASPE report.  Bump the Medicaid enrollment figure to 13.4 million errors well on the side of caution, falling well below the average increase in Medicaid enrollment for the past three reported months.


Drum Roll Please

If we were to assume that since January 1, 2014 no uninsured person eligible to participate on the healthcare Marketplace became insured through their employer or an off-exchange insurer, then by removing the number of individuals who have taken advantage of the Medicaid Expansion (13.4 million) from the total reduction of the uninsured since open enrollment began (15.3 million) we would arrive at the number of individuals who have obtained healthcare insurance through the state and federal exchanges.  Under these assumptions, 1.9 million people obtained healthcare insurance through the state and federal healthcare exchages.

Out of the pool of 28 million uninsured who are qualified to participate on the ObamaCare created healthcare Marketplace, no more than 1.9 million have done so over the course of two open enrollment periods.  That does not speak will for the healthcare law that was intended to bring these 28 million people access to affordable healthcare.  1.9 million is also significantly less that previous projections and is less than 20% of the administration targeted enrollment for 2015, as originally forecasted by the CBO and used to sell ObamaCare.  This is also in no way, shape or form what was promised to the American people when congressional Democrats and the President jammed this law down our throats.

And 1.9 million still does not represent the number of people who actually purchased a healthcare plan through the state and federal healthcare exchanges as it still includes those who gained healthcare insurance through their employer and those individuals who purchased healthcare insurance through a private or off-exchange source.


How Much Worse Does it Get?

It gets quite a bit worse actually. 

We do not know the breakdown of the 1.9 million people who gained healthcare coverage through other means than the Medicaid Expansion but what we do know is that, since the opening of the healthcare Marketplace, 5 million new jobs have been created.  If just 10% of those new jobs provided healthcare insurance to their new employees this 1.9 million figure would be reduced by a half million.  If 44.5% of those new jobs provided healthcare insurance to their employees, as reported in a 2013 Gallup-Healthwaystudy, it would wipe out the 1.9 million figure in its entirety and then some.

How many of these new jobs are providing the employee with healthcare insurance we do not know but I think it is more than safe to assume that more than 10% do and it would not be inconceivable that 40% could be doing so, based on current trends.  This certainly gives us something to think about.  And let’s not forget, there are still those individual who purchased their healthcare plans off-exchange.


And It Could Be Even Worse!

Gallup-Healthway Well-Being is not the only industry expert studying the effect that ObamaCare has had on the reduction of the nations uninsured.  Other well respected organizations such as the Rand Corp, the Commonwealth Fund and the Urban Institute all have performed similar studies with varying results.

For example, sometime after the close of the first open enrollment period, each of these groups conducted their own studies on the effect ObamaCare was having on the reduction of the uninsured. Their results ranged from 9.5 million to as low as 8 million.  For the same period the Gallup-Healthway survey concluded a reduction of 10.3 million, more than 20% higher than the lowest resulting study.  It would be impossible to determine which of these studies was the most accurate and it is not important to do so.  What is important is to understand and accept that there could be as much as a 20% variation in the results of these studies. 

Clearly, which study HHS choses to adopt to represent the overall reduction of the nations uninsured will have a significant impact when determining the number of people who could have possibly obtained a healthcare plan through the state and federal healthcare exchanges.  If you were to lower the current adopted figure of 15.3 million by 20% you would actually arrive at a net negative enrollment through the exchanges.  (12.2 million – 13.4 million)
 

Enrollment May Even Be Upside Down

The pool of 28 million people qualified to participate on the healthcare Marketplace may have actually grown since open enrollment began.

As many as 2.2 million people are likely to have gained healthcare insurance through their new employer since ObamaCare enrollment started.  This figure surpasses the 1.9 million maximum non-Medicaid Expansion enrollments to date.  For this to happen the pool of uninsured qualified to participate on the healthcare Marketplace would have to grow by 300,000.  Of course, every one of those 2.2 million who likely gained insurance through their employer were not all uninsured but a good majority of them were.

A fair look at the overall reduction of the nations uninsured would all but close the gap between the overall reduction figure and those who have taken advantage of the Medicaid Expansion.  There being a 20% disparity between the results of the highest and lowest studies conducted by four of industries leading experts, if we were to take the average results the overall reduction in the nation’s uninsured would be reported at roughly 13.8 million.  With 13.4 million having taken advantage of the Medicaid Expansion, this accounts for almost all of the nation’s reduction of the uninsured leaving virtually all of the pool of 28 million eligible to participate on the healthcare Marketplace untouched. 

If the full 20% disparity were applied, the overall reduction in the nation’s uninsured would be reported at around 12.2 million.  Taking in to consideration the 13.4 million who have taken advantage of the Medicaid Expansion, this would mean that the pool of 28 million people who are eligible to participate on the healthcare Marketplace would have to grow by 1.2 million.


One Last Point

All this number crunching has my head spinning but it is important to take the time to drill down on these figures and understand how effective (or ineffective) the individual mandate has been in reducing the pool of 28 million uninsured Americans who are not qualified for Medicaid.   As you can see, things do not look so good, in fact that look beyond terrible.  Based on these finding, the Individual Mandate is a total failure and may actually be driving the uninsured rate up instead of down.

This was concluded using numbers derived, adopted and published by HHS and therefore are endorsed by the Obama Administration.  These are their numbers, they own this!

ObamaCare Could Realize a Net Negative Enrollment in 2016

Department of Health & Human Services (HHS) Secretary Sylvia Burwell released a news brief last week which laid out her projections and an overall assessment of what we should expect from the forthcoming ObamaCare open enrollment period.  As per usual, the brief was littered with less than meaningful facts and figures along with a few key points sprinkled in between! 

Burwell did do a good job of tamping down enrollment expectations for 2016 although I do not believe she went far enough, but understandably so, as by all accounts there will be fewer insured on the individual marketplace at the end of 2016 than at the end of 2015.  Burwell also reported something quite unusual, she actually provided figures for the number of uninsured they project will gain coverage this enrollment period, something that has not been done since before the start of the first open enrollment period, back prior to October of 2013.

In her news brief Burwell states:

Finally, there are those who will come from the 10.5 million eligible uninsured. We expect to draw in about 2.8 million to 3.9 million of those individuals.

Burwell predicts that somewhere between 2.8 to 3.9 million uninsured individuals will purchase a healthcare plan through the state and federal healthcare exchange this coming open enrollment period.  That’s a pretty lofty goal when you consider the abysmal turnout by the uninsured during the first two open enrollment periods, turnout which yielded fewer than 2 million¹ enrollments combined.

It’s hard to imagine that with the news of significant premium increases coming in 2016 and the law’s continued loss of popularity, that as many as twice the number of uninsured who have enrolled over the past two open enrollment periods will elect to do so in 2016.  In fact, I am going to call foul on this prediction and make my own, that enrollment of the uninsured will be around 1 million.

I must also take exception to the 10.5 million eligible uninsured, as stated by Burwell in her news brief.  This is a gross misrepresentation of the pool of uninsured individuals eligible to participate on the healthcare Marketplace.   I address this misrepresentation in an earlier blog titled HHS Makes 14.1 Million Uninsured People Magically Disappear.


A Net Negative Enrollment

It’s not where you start, it’s where you finish and two full years after the implementation of the individual mandate and only 3 months left in the year, HHS is projecting that 2015 will close with an effectuated enrollment of 9.1 million.  What HHS does not disclose in their projection is that fewer than 2 million¹ of those enrolled were from the pool of 28 million uninsured, eligible to participate on the healthcare Marketplace.

Looking forward, HHS is projecting that 2016 will close with an effectuated enrollment between 9.4 million and 11.4 million.  Considering the starting point was 9.1 million, this projection does not look very optimistic.  And when you take in to account the administration’s history of grossly overstating the number of uninsured who will participate on the exchanges, you begin to gain the sense that enrollment could actually take a turn in the negative direction.

Consider if you will, that after 2 open enrollment periods, which together provided consumers 9 months of opportunity to purchase a qualified healthcare plan, fewer than 2 million¹ did so.  Also consider that those who did so were largely the most elderly and least healthy in the pool of uninsured, those with the most incentive to secure healthcare that was previously very costly or denied to them altogether.  With this in mind, it is hard to fathom that between 2.8 to 3.9 million uninsured individuals will purchase a healthcare plan through the state and federal healthcare exchange this coming open enrollment period as Burwell suggests in her newsbrief. 

A more realistic enrollment projection than that suggested in Burwell’s news report is something more in line to the average participation of the uninsured over the past two open enrollment periods, which is just under 1 million.  And when you substitute 1 million in place of the HHS 2016 projections, enrollment actually drops below 2015 numbers.

Achieving a net negative enrollment will not bode well for ObamaCare and will make it more difficult for Democrats to argue against the Republican effort for a full or partial repeal of the law.  And rest assured, once the 2016 open enrollment period closes and the dust settles, Republicans are going to make a big issue with the fact that the individual mandate has hardly put a dent in the pool of 28 million uninsured who are qualified to participate on the healthcare Marketplace.

¹ HHS reports that the nation’s uninsured has dropped by 15.3 million since January 1, 2014.  At the same time CMS reports that 13.5 million individuals have taken advantage of the Medicaid expansion over the same period.  The difference between enrollments is 1.8 million which accounts for all on exchange and off exchange individual plans purchased.

HHS Makes 14.1 Million Uninsured People Magically Disappear

Competing with all the election news and troubles in the Middle East last week, it didn’t take long for 2016 ObamaCare enrollment projections to get lost in the noise.

Last Thursday, Department of Health and Human Services (HHS) Secretary Sylvia Burwell released a news brief in which, buried amongst dozens of facts and figures, she released the less than stellar enrollment projections for the forthcoming opening of the ObamaCare exchanges.

 

“Finally, there are those who will come from the 10.5 million eligible uninsured. We expect to draw in about 2.8 million to 3.9 million of those individuals.” 

HHS expects that somewhere between 2.8 to 3.9 million uninsured individuals will purchase a healthcare plan through the state and federal healthcare exchange this coming open enrollment period.  While this figure is significantly lower than the 6 million originally projected when the law was passed, considering the abysmal turnout by the uninsured during the first two open enrollment periods, this is actually is a pretty lofty goal.  But I will save my amateur analysis of what I believe is Burwell’s unachievable enrollment projections for my next blog.  For now, there is a much more sinister figure reported in her news brief that needs to be brought to light.

Where Did This Number Come From?

10.5 million eligible uninsured, did I read that right?  Seriously, where did this number come from?  I’m pretty in tune to all the facts and figures related to ObamaCare enrollment and 10.5 million is not a number that I am familiar with.  But that’s okay, since it represents the number of uninsured eligible for Marketplace coverage, it should be simple to validate, all we need is a starting point and the number of long term uninsured that have purchased and maintain a qualified healthcare plan through one of the state and federal healthcare exchanges to reduce it by.

First, the starting point.  In 2009 the US Census Bureau reported that 48 million Americans lacked health insurance.  Of those 48 million, 29 to 30 million were eligible for Marketplace coverage.  The balance, of course, would be those qualified for Medicaid. 

Next, the number of long term uninsured that have purchased and maintained a qualified healthcare plan.  As no department of the Obama Administration reports this number specifically, we are going to have to do the leg work ourselves.  Fortunately HHS does provide us with enough information to do so.

From the HHS ASPE Data Point report released on September 22, 17.6 million uninsured individual are reported to have gained health insurance coverage since the implementation of the Individual Mandate on January 1, 2014.  This figure includes all forms of individual healthcare insurance including on-exchange purchases, off-exchange purchases and Medicaid.  For roughly the same period, the Centers for Medicare & Medicaid Services (CMS) reported that there were 13.2 million individuals enrolled for Medicaid as a direct result of the Medicaid Expansion.  When we reduce the total number of those who have gained healthcare insurance by the number who have gained coverage through the Medicaid expansion we are left with 4.4 million {4.4 million is a significant overstatement of the actual on-exchange enrollment which I will address in my next blog}. 

So, if there were around 29 million in the pool of the uninsured eligible for Marketplace coverage at the start and we reduced that number by the 4.4 million uninsured who purchased a healthcare plan during the first two open enrollment periods then the remaining pool of uninsured should be roughly 24.6 million.  Wow, that’s a far cry from the 10.5 million HHS is reporting. Somewhere, somehow HHS made 14.1 million uninsured people magically disappear!


Where did the 14.1 Million Missing Uninsured Disappear To?

The better question is, where did HHS come up with 10.5 million as the number of uninsured eligible for Marketplace coverage?  And I have that answer!

Sadly, but hardly surprising, HHS willfully mislead the American people.  HHS arrived at their 10.5 million figure simply by reducing the original pool number of 28.1 million¹ by the 17.6 million reported to have gained healthcare coverage in the HHS ASPE Data Point report.

Likely at the direction of the White House, since the day the healthcare exchanges first opened, HHS has routinely misrepresented Marketplace enrollment by including Medicaid expansion participants in to the count.  Less than 25% of the 17.6 million HHS used to derive the 10.5 million figure actually makes up enrollment through the healthcare exchange.
¹ The size of the pool varies slightly depending on which source is use.  I chose to use the US Census Bureau figure as it is easily verifiable, HHS uses CBO data which also varies from one report to the next.


Why Would They Do Such a Thing?

Tell me, what looks better to the people, reducing the number of uninsured from 28 million to 24 million or reducing the number of uninsured from 28 million to 10.5 million?  Reporting a greater reduced pool of uninsured helps the Obama Administration play down the failure of the Individual Mandate.  The Obama Administration started doing this the first day the healthcare exchanges opened and has been doing so ever since.  And what has the media done?  The media has given the administration a fee pass on this gross misreporting of the numbers.

The faux 10.5 million figure also helps to improve how participation of the uninsured looks.  Let’s assume, for example, that HHS meets their projected goal of 4.4 million uninsured enrolling through the healthcare exchanges.  This would equate to the enrollment of 1 out of every 2.3 of those eligible to purchase a healthcare plan as opposed to 1 out of every 5.7 of those eligible to purchase a healthcare plan if compared to the actual uninsured pool of 25 million.


ObamaCare is without a doubt in serious trouble and the intentional misrepresentation we see here is affirmation of that.  And with guaranteed premium increases coming for 2016, we could be looking at a net negative enrollment this coming open enrollment period.

How many have actually purchased and continue to retain a qualified healthcare plan from the pool of 29 million eligible to participate on the Marketplace has not been answered definitively and remains one of the best kept secrets of the Obama Administration.  But as more enrollment information finds its way to the public a better picture of past, present and future enrollment can be painted, which is the topic of my next blog.

ObamaCare - Do You Remember How We Got Here?

For those millions of American’s who sing praise and support to President Obama for all the years of hard work and dedication he put into bringing affordable healthcare to those Americans who have none, you might not want to read this!

 

Back Before ObamaCare

Unlike so many rising stars of both the Democratic and Republican Party who gained their recognition through their outstanding work and service, Barack Hussein Obama's story is quite different. 

Obama was a Junior Senator who was all but unknown outside the Democratic Party and the Senate.  With a near empty resume and almost no name recognition, it was a by chance  opportunity, created by none other than John Kerry, which brought Obama to the stage of the 2004 Democratic National Convention.  It was through a speech he gave at the convention that Barack Obama gained his star status.  The audience found this unknown black Senator from the State of Illinois to be both captivating and inspirational.

Most outside the black community could not have told you that Obama had a book on the #1 Best Sellers list in 2006, courtesy of Oprah Winfrey.  Before becoming a household name, those familiar with Senator Obama described him as the young Senator who gave a rousing Keynote Address at the 2004 DNC.  It was at that time which Barack Obama caught the attention of a few senior Democrats who saw “marketing potential” in this young, energetic and well-spoken Senator.

Early into his bid for the Democratic Presidential nomination Obama was heavily criticized by many political analysts for not having enough experience to be a serious candidate.  And it was not long before Senator Obama helped to prove that point.  It was during an early campaign speech, in front of a group of union members that his inexperience and ill preparedness was first brought to light.

The then Senator Obama had stated many times prior, his position on desiring a single payer type, Universal (government run) Healthcare system yet he had failed to delve any deeper into his stated position then his fundamental idea.  His failure to have ever formulated an actual healthcare plan caught up to him shortly after throwing his name in the hat for the 2008 democratic presidential nomination.  While speaking before a group of union members at a campaign event, Senator Obama was asked to provide a few details of his proposed healthcare policy.  It was at that moment that Senator Obama realized he had not so much as even develop talking points to his vision of healthcare reform much less put together its actual framework.  The fundamental transformation of the nation’s healthcare system was to be one of the key platform items of his candidacy run and what would become the cornerstone of his platform during his run for the presidency.  But at that moment Obama  had to ad-lib which created an embarrassing moment for both himself and the Democratic Party.

Amid their busy campaign schedule, candidate Obama (or more likely members of his staff) hastily threw his healthcare platform together and in late May of 2007 he unveiled his Universal HealthCare Plan.

 

Obama and Hillary Debate

Healthcare reform was a hot topic of discussion between Clinton and Obama while campaigning for the Democratic presidential nomination.  The fundamental difference between their two healthcare plans was the “individual mandate”.  Ironically, the individual mandate was not part of candidate Obamas plan at the time but was however included in Hillary’s.  When questioned on his thoughts regarding an individual mandate, candidate Obama rebuked the idea stating that it would “force” everyone to buy healthcare insurance.  Throughout their campaigns, the individual mandate was a favorite target of Senator Obama’s, stating regularly that if you chose Hillary’s plan you would be forced, by the government, to purchase healthcare insurance while with his plan your freedom would remain intact.

Senator Obama went on to win the Democratic presidential nomination and then the presidency in large part due to the promises he made to transform the healthcare system to a non-intrusive and highly affordable one.

 

Creating ObamaCare

Immediately after changing his residence to the White House, President Obama instructed congress to get to work on a Universal Healthcare plan that he wanted signed into law while in his first year in office.  The house floated several bills but it was the Senate bill, with its bi-partisan support, that stuck to the wall best with Democrats.  This early Senate bill became the framework for Obama’s healthcare transformation.

The first real hurdle came when Senate Democrats, at the advice of health policy experts, had to persuade the President to adopt a number of congressional proposals the most significant of which was the individual mandate, something that the President and vehemently opposed throughout his campaign.  But politics as they are, the President traded promise and integrity for political posturing as the more liberal healthcare reform ideals he campaigned on would not likely survive a filibuster.  It must be noted that the particular industry expert that pushed the President to adopt the Individual mandate was none other than Jonathan Gruber.  Yea that guy that the President, Nancy Pelosi and many other Democrats who were involved in creating the ObamaCare legislation not so long ago claimed they had hardly a recollection of who he was and also stated that he played a very small role in the shaping of ObamaCare.

The flip flop on the individual mandate would be the first of nearly a dozen political manipulations and stunts pulled by Harry Reid, Nancy Pelosi and the President’s Executive Pen in hand.

 

We’ve Got This (at any cost)

At this point it became blatantly clear to Republicans that there was going to be nothing bi-partisan about the Affordable Care Act.  The bill would ultimately be crafted by a few key democrats in the Senate who had long dreamed of pushing their vision of Universal Healthcare and this was their big chance.

The individual mandate led to what would become the most telling of Democratic political plays, the “it’s a tax, it’s not a tax” individual mandate flip flop.  Early on, to appease certain congressional lawmakers, democrats were adamant in their position that the individual mandate was absolutely not a tax.  In certain courts, Democrats argued that the individual mandate was a tax while in other courts they argued that it was not, it just depended what Democrats needed the mandate to be for the particular fight they were engaged in.  In the final make-or-break battle, Democrats needed the Supreme Court to rule that the individual mandate was in fact a tax.  This was the final hurdle Democrats needed to clear in order to pass ObamaCare in to law and as we know, the Supreme Court ruled that the individual mandate was in fact a tax.

Maybe the most controversial yet media downplayed of antics that took place to secure the necessary votes for ObamaCare was the conviction of Alaska’s U.S. Senator Ted Stevens (R), a conviction that was later dismissed due to gross prosecutorial misconduct and the withholding of evidence.  Even though Stevens was dismissed of all charges, the damage was done both to Stevens political career and of course the removal of the vote that would have blocked the ObamaCare bill from being past in the Senate as Stevens would have surly voted against it.  There were two other highly controversial Senate seats lost that would have surly been a thumbs down vote for ObamaCare but without the support of the media, it is impossible to gain public attention to possible misconducts and we all know were the allegiance lies with the majority of the media.

Budget impropriety also had its place in the crafting of ObamaCare.  In an effort to avoid breaking certain budget rules that would have forced Democrats to engage in budgetary proceedings that would have without a doubt taken away their super majority, some savings claims of the bill were double counted while certain spending were mislabeled so as not to be included in the tally of the bills projected cost.  This was all revealed after the fact but as we know, after the fact means absolutely nothing.

Pro-life Democrats got the shaft as well although only through their own ignorance.  To circumvent their concerns of public funds being used to conduct abortions, President Obama convinced those pro-lifers that through Executive Order, he had the power to influence the intent of the law.  And so, with a quick sweep of the executive pen, it was made so.  However, in the end, Obama’s executive action had no effect on the law.

And there were many more such tumultuous manipulations and maneuvers along the journey to the final passage of the Affordable Care Act!

 

Selling their Souls and Selling Out the American People

The crafting of the ObamaCare bill in such a way that it could not be opposed by Republicans became an ugly process.  While the bill, in most accounts, appeared to be within the law it certainly pushed politics far beyond the boundaries of moral and ethical conduct, even for politicians.  From the start, it was evident that the guaranteed passage of healthcare bill held far more importance to Democrats than the actual content of the bill, which kept the president largely disengaged from the process.  Democrats were making history here for Pete’s Sake!

For a piece of legislation as significant as a national healthcare bill, one would think that the Will of the People would have been deserving of much more consideration than given by the Democrats who willfully ignored the very loud calls of opposition across the nation.  As well, in the decision process of signing a bill of this magnitude in to law, who would have ever imagined that a president would even consider putting pen to paper when not so much as a smidgen of bipartisan agreement existed?  But such was not the case with ObamaCare, a bill which no House or Senate Republican support nor ever held the support of the majority of the American people.

President Obama and the entire Democratic Party know full well why ObamaCare is so strongly opposed by the majority of American people as well as by small businesses; large corporations; unions and their Republican counterparts, but they simply do not nor have they ever cared.  From the start, Democrats have been so deeply invested in ObamaCare that it has made it impossible for them to admit any degree of the laws failure regardless of circumstance.

US Census Report Reveals Net Negative Insured Rate in Healthcare Exchange Enrollment for 2014

It has proven all but impossible to pin down the effect that the Individual Mandate had on reducing the number of uninsured in 2014.  But despite the efforts put forth by the Obama Administration to withhold specific enrollment information, a report just released by the US Census Bureau has provided a much clearer understanding of how the Individual Mandate influenced enrollment through the healthcare exchanges in 2014.

Back in February of this year, the Centers for Medicare & Medicaid Services (CMS) revealed that in 2014, 10.75 million individuals gained healthcare coverage through the Medicaid and CHIP programs.  From the CMSreport:

 

Looking at the additional enrollment since October 2013 when the initial Marketplace open enrollment period began, among the 49 states reporting both December 2014 enrollment data and data from July-September of 2013, over 10.75 million additional individuals are enrolled in Medicaid and CHIP as of December 2014, approximately an 18.6 percent increase over the average monthly enrollment for July through September of 2013.

 

Fast forward to earlier this month, the US Census Bureau released its report on health insurance coverage in the United States in 2014.  The report concluded that compared to 2013, the number of uninsured individuals in the United States decreased by 8.8 million.  From the USCensus Bureau report:

 

The uninsured rate decreased between 2013 and 2014 by 2.9 percentage points. In 2014, the percentage of people without health insurance coverage for the entire calendar year was 10.4 per­cent, or 33.0 million, lower than the rate and number of uninsured in 2013 (13.3 percent or 41.8 mil­lion).

 

These two reports cannot make it any clearer.  The number of uninsured dropped by 10.75 million through Medicaid/CHIP enrollment in 2014 yet the overall drop in the number of uninsured in the nation fell by a lesser 8.8 million over the same period.  In other words, more people gained healthcare coverage through Medicaid/CHIP than the overall drop in the number of uninsured.  This means that someplace 1.95 million insured America’s were lost and that someplace is through the healthcare insurance exchanges.

That’s right, according to the data provided by these two respected government sources (yes we are using their numbers), at the end of the 2014 open enrollment period there was a net negative number of people insured from the pool of non-Medicaid qualified individuals with 1.95 million fewer having a healthcare plan than when the healthcare insurance exchanges opened for the first time six months earlier.  Not a great testament to the success of the Individual Mandate now is it.  And keep in mind, this 1.95 million does not represent the entire pool of formerly insured who dropped out of the insurance marketplace in 2014. 

While we do not know the exact figure, various industry sources estimate the number of long term uninsured individual who purchased and maintained a qualified healthcare plan through the exchanges in 2014 to be someplace in the neighborhood of 1.0 and 1.5 million.  Whatever that figure actually is, there were the same number of formerly insured who dropped out of the insurance marketplace in 2014.  In other words, to support the US Census Bureau’s reported 8.8 million reduction in the uninsured, for every long term uninsured individual that purchased and maintained a healthcare insurance plan in 2014, one formerly insured individual had to drop out of the insurance marketplace.  So if 1.5 million of the nation’s long term uninsured did in fact purchase and maintain a qualified healthcare plan through one of the state and federal healthcare exchanges in 2014 then 3.45 million formerly insured individuals would have had to drop their insurance plans (1.5 million to offset new enrollees plus the 1.95 million overall reduction in the number of insured prior to the opening of the exchanges) to maintain the 8.8 million reduction reported by the US Census Bureau.

A dropout rate of this size is not at all inconceivable.  We do know that at the same time the 2014 open enrollment period opened, millions of individual healthcare plans were canceled for non-ACA compliance.  The actual number of cancelation notices sent out by insurers is highly debated, the most accepted number being 4.7 million as reported by the Associated Press.  We do not know how many of those who had their insurance plans canceled purchased a new ACA compliant plan nor do we know how many who did not receive a cancelation noticed dropped out of the marketplace voluntarily, but we know many did.      


So What Does This Mean?

What this means is in its inaugural year, ObamaCare proved to be nothing more than an incredibly expensive social entitlement program.  That’s right, in 2014 ObamaCare managed to provide 10.75 million low income individuals access to taxpayer funded, lesser quality healthcare while at the same time managing to increase the number of the uninsured who were qualified to purchase healthcare plans through the state and federal healthcare exchanges by nearly 2 million rather than shrinking they pool by 7 million as President Obama claimed the individual mandate would, during its first year.

In the minds of most liberal democrats, having the affordability driven out of healthcare plans purchased by hard working Americans, even to the extent that more lose their healthcare plans than gain them, is a justified means to fund more government dependency to an expanded level of lower income individuals.  To these same liberal democrats, the failed obligation of the law to serve the working middle class is obviously of no consequence.


How Long Will the Left Ignore the Failure?

As long as those on the left are allowed to remain willfully ignorant, the failure of the Individual Mandate will go on unabated.  So the real question that needs to be asked is how long will the left be allowed to remain willfully ignorant?  

The close of the 2016 open enrollment period is likely the answer to this question.  Once the open enrollment period closes, the start of a major Republican campaign to bring to light all the failures of ObamaCare, especially the Individual Mandate will begin.  Maybe not willfully, but Democrats will have no choice but to engage themselves in to the conversation at that time.  

Assuming that participation by the uninsured remains as anemic as it has through the first two open enrollment periods, the reduction of the pool of the uninsured who are qualified to participate on the healthcare exchanges will face a 70-80% projection shortfall.  This will leave Democrats with no means to defend the failure of the Individual Mandate and therefore they will be forced to concede that ObamaCare has truly turned out to be nothing more than a costly Medicaid expansion.

Scoring the 6 Major Provisions of ObamaCare

There are literally hundreds of provision contained within the ten titles that make up the 2700 plus pages of President Obama’s namesake healthcare law, most of which nobody has ever heard of or even read, including many of the Democratic Lawmakers responsible for the law’s passage.

Of the many provisions that make up the ObamaCare law, there are six that specifically pertain to the delivery of healthcare to new, as in the pool of this nation’s long term uninsured, customers which of course is the primary objective of ObamaCare.  So let’s take a look at these six provision and see just how much of a bang we the people are getting for all our bucks that are finances this behemoth healthcare legislation. 

Following is a short description of each of the provisions and a brief look at the effectiveness of each compared to the goals they were set to achieve.  From this we will score each provision as either a success or a failure.


#1 Guaranteed Issue

Guaranteed issue is the provision in the ObamaCare law which prevents insurers from discriminating against an individual who suffers from a high risk/high cost medical condition.  No longer are insurers able to ask for a person’s medical history and use that information to rate a plan or deny coverage.

The guaranteed issue provision went in to effect shortly after ObamaCare was passed in to law.  It would not be until 2014 however, that individuals would be able to purchase a qualified healthcare plan through one of the health insurance exchanges.  As a stop gap, the Department of Health and Human Services (HHS) put the Pre-Existing Condition Insurance Plan (PCIP) provision in place.

In the creation of the PCIP stop gap provision HHS projected that 375,000 individuals, suffering from a high risk/high cost pre-existing condition, would enroll on the plan.  But sadly, at its peak, only 135,000 chose to participate.  One of the primary reasons for the low enrollment was cost!  Over the next two years PCIP rates were reduced by 20% yet there was a continued decline in the programs enrollment.  By the time the health insurance exchanges rolled out, PCIP participation had dropped to roughly 108,000.

Low enrollment was not the only issue the PCIP provision faced.  The cost to operate the program also became a major issued as HHS grossly underestimated the make-up of the risk pool which consisted mainly of those with very costly conditions such as advanced heart disease and cancer.  The low enrollment issue in many was the saving grace for the PCIP provision as the 240,000 enrollment shortfall helped to offset the 250% error on cost projection and funding for the program.  In fear of running the plan out of money, in February of 2013 HHS terminated new PCIP enrollment however, this was likely an unnecessary precaution as participation was well on the decline.  At about the same time, HHS shifted more of the cost back to the customer in the way of higher premiums and out-of-pocket responsibilities.

And last, when it came time for those participated on the PCIP program to select a qualified healthcare plan and transfer over to the health insurance exchanges, only 80,000 did so over the 6 month initial open enrollment period and three granted extension periods.

When the closing bell ran, ending the PCIP program, there was a 41% loss in participation from the provisions peak to the number of those that transfer to a qualified healthcare plan through the health insurance exchanges.  That’s right, for a large percentage of those with a high risk/high cost pre-existing healthcare issue, they still found insurance too costly to purchase.  And with the price of the insurance plans having increased in 2015 and will again in 2016, it is not likely that the number of those with a pre-existing condition and still without healthcare insurance will improved any.

Considering all the shortcomings of the PCIP stop gap provision, (the low transfer rate to the health insurance exchanges and the continued rise in program cost) I don't think anyone can argue against the fact that the Guaranteed Issue provision of the ObamaCare law has fallen grossly short of its intended goal of bringing healthcare to those with a high cost/high risk pre-existing medical condition.  It is because of these factors that we can, without hesitation, score the Guaranteed Issue provision as a complete and utter FAILURE.


#2 Minimum Standard

The minimum standard is the provision of ObamaCare to which without, the law could not exist. 

Each and every healthcare plan sold, be it through an employer provided group plan; an individual plan purchased through the health insurance exchanges or a plan purchased directly from the private insurance marketplace must meet a certain minimum standard of coverage.  Labeled as the “essential health benefits” (EHB) package, the answer as to what the purpose is of this package depends on who you ask.

For those who crafted the law and its staunch proponents, the story goes that the EHB brings a higher quality of healthcare to each individual, this by making it mandatory for healthcare providers to give FREE care away as well as being sure that every form of care that could ever be needed is included in your healthcare plan.

Of course, there is a cost associated with all those “extras” in a healthcare plan which often raises the question as to why a male adult would need child dental coverage or why a women of post-child baring age would need pre-natal care coverage.  The list of unusable essential benefits goes on and on and leads us to the real purpose of minimum standard and EHB.

It would be wonderful to think that the crafters of ObamaCare bundled all the EHBs together in the best interest of all Americans but the reality is the EHB package, created to meet the minimum standard, only exists as a means to create the revenue stream needed to cover other obligations of the healthcare law, primarily the guaranteed issue.  Now that insurers are no longer able to discriminate nor charge more for those with a pre-exiting condition, they needed a new revenue stream to pick up these costs. 

The administration’s idea was to model individual healthcare plans similar to those offered to employer based, large group plans which already bundled most if not all of what was now being mandated in the EHB packages.  The problem with this approach was however, the fact that the employer based plans cover a pool nearly six times as large as the pool which participated on the individual market, thus giving the employer based plans a significantly larger universe to spread costs over.  Prior to ObamaCare, it was the insurer’s ability to offer an individual a plan, more tailored to their specific needs, that leveled the playing field and kept individual and employer provided policy costs on a parallel with one another.  With this leveling mechanism taken away from insurers, the cost of individual plans had no place to go but up and up they went, substantially.

The minimum standard provision does accomplish it objective.  However, it cannot be ignored that the Obama Administration’s intentional misrepresentation this provision as being a consumer benefit rather than the new revenue stream it actually is and for this we will have to score the Minimum Standard provision a FAILURE.


#3 Individual Mandate

With the potential to affect 25 million uninsured individuals, some would say that the individual mandate is the single most important provision of ObamaCare.

Under the individual mandate provision, everyone is now required to have healthcare insurance, with few exceptions.  For those who are not provided healthcare insurance through their employer or through a government program, they are now required to purchase their own healthcare insurance or pay a tax penalty each year which they are not in compliance of the mandate.

The logic behind the individual mandate is simple and maybe a bit naive.  The hope is that the bulk of those 25 million long term uninsured will be incented to obtain healthcare insurance now that it is federally mandated to do so and also to avoid facing a subsequent tax penalty they would incur for non-compliance.

As it turns out, the federal mandate to have healthcare insurance nor the tax penalty for non-compliance seem to have had much of an effect in incenting those 25 million uninsured to purchase a healthcare plan.  After two open enrollment periods, totaling nine months in length, the number of American’s non-elderly, long term uninsured decrease by a mere 3 million.  This equates to about a 70% shortfall from the administrations 2015 enrollment projection.

There are several reason for the lack of participation by these 25 million uninsured Americans, the largest continuing to be cost.  Despite all the campaign rhetoric and promises of lower premiums, the cost of healthcare insurance for individuals is significantly higher now than prior to the passage of ObamaCare.  Individual plan rates increased between 40 and 100 percent even before the mandate kicked in in January of 2014.  Since that time premiums have continued to rise, pricing many more out of healthcare insurance before they ever obtained it.  For the young and healthy this was especially true as, in the structuring of the insurance rates, they were burdened with the lion’s share of the load.

Even with subsidies (which we will discuss in a moment), most of the uninsured seem to find the cost of purchasing healthcare insurance too great a burden on their household finances.  For other, the cost still remains too high to make healthcare insurance obtainable.

There is a bit of irony to the individual mandate as well.  For those that followed the 2008 battle for the Democratic presidential nomination, you may recall the bitter swipes between Hillary Clinton and Barack Obama over the differences in their healthcare plans.  Then Senator Obama strongly opposed the individual mandate, a key component of HillaryCare 2.0.  Obama made many public statements condemning the mandate, calling it a government overreach that it takes away American freedoms.  It was not until after now President Obama was told by his team that without the individual mandate they would never gain enough democratic support to pass a healthcare bill that the president fell head over heals in love with the idea of the individual mandate.

It is for this telling bit of irony and the failure to incent the uninsured into purchasing healthcare insurance that the Individual Mandate provision scores a DOUBLE FAILURE!


#4 Healthcare Insurance Exchanges

The concept of healthcare insurance exchanges is not new as several states have, in the past, tried the concept, all with less than desirable outcomes.  The success of healthcare insurance exchanges is a delicate balance that relies on the creation of strong competition amongst participating insurers which in turn will create a large and stable risk pool thus minimizing adverse selection.  This is by no means an easy feat to accomplish.

From the layman’s perspective, the healthcare insurance exchanges are little more than a portal to which customers can conveniently shop the variety of insurance plans private insurers are offering in their particular region.  It is not mandatory for individuals to purchase healthcare plans through the exchanges however, to take advantage of any tax subsidies that may be available to them, the only way to do so is through the exchanges.

For HHS and the private insurers, the exchanges play a critical role in marketing and creating competition in the small-group and individual markets.  The exchanges oversee the standardization of plan benefits and cost-sharing and also bear the burden of restraining premium growth.

On the surface, the ObamaCare healthcare insurance exchanges look quite successful with close to 12 million plans purchased through them during the 2015 open enrollment period.  Unfortunately, only about 25% of those enrollments came from the 25 million in the pool of the long term uninsured, those in which the entirety of the law is premised.   The make-up of the enrollees does not fall in favor of the healthcare insurance exchanges either with only 24% of those enrolled coming from the pool of young and healthy adults.  To avoid the perils of adverse selection, target enrollment of the young and healthy was 39%, as stated by the HHS.

Politically, the saving grace for the exchanges has been the 75% of enrollees who transferred over from the individual marketplace, most of which were recipients of policy cancelation for non-ACA compliant plans, you know, those folks that did not get to keep their plan even though they liked their plan!  Proponents of the law have used these 9 million policy transfers to claim a faux victory for the healthcare insurance exchanges.  Insurers and opponents of the law see things quit differently however.

For insurers, there incentive to participate on the healthcare insurance exchanges was the prospect of as many as 25 million new customers, 10 million of which were projected to have signed up by the close of the 2015 open enrollment period, according to the non-partisan Congressional Budget Office (CBO).  But with new customer enrollment currently around 3 million, insurers are not liking what they are seeing. 

To protect themselves from loses, insurers are imposing significant rate hikes for 2016 thus dashing any hopes of the massive new enrollment surge needed to make future participation in this new insurance scheme possible.  Also, insurers soon lose their protection from losses incurred on the exchanges as the risk corridors provision expires at the end of 2016.

Opponents see a moral responsibility attached to the healthcare insurance exchanges.  Through the partisan deal brokered by Democrats, 16 million Americans are expected to have purchased a healthcare plan through the exchanges by the close of the 2016 open enrollment period.  But the exchanges thus far have fallen far short of expectations and it looks as though they will struggle to insure even half of the intended uninsured population.  This will leave millions of Americans, whom the law was intended to help, out in the cold.  Opponents believe that the American people deserve better than to settle for the significant enrollment shortcomings being experience through the healthcare insurance exchanges.

It will take nothing short of a miracle for new enrollment to achieve even half of what was projected when ObamaCare was passed in to law.  So for failing to control costs, adverse selection and most of all, leaving millions of uninsured Americans out on the cold, the Healthcare Insurance Exchange provision is scored as a FAILURE!


#5 Low Income Subsidies

Low income subsidies are an essential provision of the ObamaCare law.  They are used to drive affordability into healthcare insurance plans for those that meet the low and middle income criteria established in the law.  Distributed based on a calculation with which only the number of family members and income level are considered, the low income subsidies is not the kind of provision that can be scored as a success or failure.  As to whether or not the low income subsidies are making healthcare insurance affordable, that’s a whole other story.

Unfortunately, due to a number of missteps by the administration to accurately anticipate the physical cost of a healthcare plans that would be offered on the healthcare insurance marketplace {the Gruber affect}, even with low income subsidies millions have still found it impossible to afford healthcare insurance.  And in a sad but true bit of irony, many of those who had, for years prior to ObamaCare, purchased and paid in full for their healthcare plans, they are now paying even more despite receiving low income subsidies to offset the cost of their new healthcare plan.

Another unfortunate event tied to the low income subsidies provision is a misleading statements, made by the administration, as to how the cost associated with low income subsidies are far less than originally projected.  This statement stemmed from the release of a cost projections update report by the CBO this past March.  And while it is true that in the CBO report it stated that the low income subsidies cost 20% less than earlier projections indicated, the administration’s claim failed to include the qualifiers stated in the CBO report, the most significant being that the costs were lower due to low enrollment i.e. fewer subsidies being paid out. 

So again, by the nature of the provision, the Low Income Subsidies provision cannot be scored as a success or failure.  However, the administration’s success in creating mandates which drove the cost of healthcare insurance plans out of the reach of millions, even with subsidies, scores them one big giant FAILURE.  And the administration also scores a FAILURE for their misrepresentation of the CBOs revised cost projections for the low income subsidies, labeling them a “cost savings”.


#6  Medicaid Expansion

And last, the Medicaid Expansion provision.   The Medicaid Expansion is a provision in ObamaCare which increases the income threshold used to determine an individual’s Medicaid eligibility.  In its original form, the expansion was projected to expand healthcare access to roughly 17 million low income adults and children across all 50 states and the District of Columbia.

The success of the Medicaid Expansion having brought access of healthcare to millions of low income individuals and children is indisputable.  But does this mean the provision itself is a success?  Let’s look a little deeper into the provision to see if it is meeting its intended goals before we make that determination.

Dating back to the infancy stages of the ObamaCare bill, many viewed the early language of the Medicaid Expansion provision as overreaching, challenging that the Federal Government did not have the authority to force individual states to comply with such a mandate.  Those challenges fell on deaf ears and when ObamaCare was signed in to law the federal mandate for all states to expand Medicaid remained. 

The administration was adamant about having the Medicaid Expansion be a federal mandate despite the clear overreach of Federal Government authority over the States, an overreach which was of course quickly challenged.  And in June of 2012, the U.S. Supreme Court ruled it unconstitutional for the Federal Government to coerce states into compliance with the Medicaid Expansion.  The Supreme Court did however leave the Medicaid Expansion intact, making its compliance optional by the states.

Some Democratic lawmakers may have believed that there was a slim chance that the federally mandated Medicaid Expansion would go unchallenged while most of those crafting the law not only knew the expansion would be challenged but also expected it to be overturned.  None the less they went forward with the federal mandate for all states to expand Medicaid, and for good reason.  The crafters of the expansion knew that they would lose the support of several key Democrats if they left the expansion to the discretion of the States which would have likely doomed the bill from being passed.  As it was, it took every single Democratic vote that was received to pass a filibuster proof bill.

The administration also underestimated the number of individuals who would take advantage of the Medicaid expansion.  They failed to recognize that the awareness campaigns, urging individuals to take advantage of the expansion, would also draw out thousands of individuals who were already eligible but were not taking advantage of Medicaid.  As a result, Medicaid enrollment has far exceeded projections which now has the states participating in the expansion scrambling to figure out how they are going to pay for it.  With few choices, expansion states will either have to cut something out of their budget or raise taxes, maybe both.  The failure to accurately project new Medicaid participation can be attributed to little more than gross incompetence by those studying the numbers and those who signed off on them.

So, is the Medicaid Expansion provision a success of failure?  From an enrollment standpoint, of course the expansion is a success, how could it not be.  The states participating in the expansion are giving away FREE healthcare to those who qualify, this is not a real hard sell.  As for the crafting of the Medicaid expansion, we cannot be so generous. 

The approach taken by Democratic Lawmakers to sell the Medicaid Expansion was a dishonest one, both in its doomed but intentional federal overreach and in pushing bad enrollment numbers.  If the crafters of the Medicaid Expansion did not intentionally provide the states with bad enrollment projections, it was their gross incompetence that missed the figures by such a large margin which now has expansion states scrambling to figure out how to pay for it.  Lawmakers intentionally sold us a bad can of fish and it is for this reason that the Medicaid Expansion provision as scored as a FAILURE.


Adding Up the Scorecard

So, there you have it, of the six major provisions in the ObamaCare law, that specifically target the delivery of healthcare to the long term uninsured population of our nation, each has failed to achieve its intended goal.  A shortsightedness of the administration to set achievable goals can be attributed to several of the provision failures, for others it is simply a matter of the administration failing to be an honest broker. 

Regardless of reason, the results are the same and despite all the failures, the Obama Administration continues to try to convince every American that ObamaCare is one of the greatest successes stories of our time.