By Bob Semro
Now that the Affordable Care Act has exceeded its enrollment goals and reduced the number of uninsured Americans, we can have some peace and quiet. Right?
Midterm elections are seven months away, but we’re already seeing political ads targeting the Affordable Care Act and legislators who supported it. Americans for Prosperity, an organization that opposes the ACA, is running one such ad in a number of states, including Colorado.
Since the ACA is sure to be a central theme in many ads, it’s worth examining some of the claims we are likely to hear again and again leading up to Election Day. (On the Americans for Prosperity ad, KUSA-Channel 9 News has an interesting fact-check and analysis — click here to see it.)
Claim: American’s don’t like the ACA
Yes, if you read only the bottom-line poll numbers, it would appear that a plurality of Americans (46 percent) has an unfavorable view of the law.
But those numbers are changing. According to tracking polls by the Kaiser Family Foundation, the number of Americans with a favorable opinion about the ACA increased from 34 percent in January to 38 percent in March, and those with an unfavorable opinion dropped from 50 percent in January to 46 percent in March.
And opposition does not mean that Americans are in favor of repealing or replacing the ACA. The number of Americans who want to keep and/or fix the law has increased from 55 percent in January to 59 percent in March. Only 11 percent of Americans want the law to be replaced with a Republican alternative, while 18 percent want to repeal the law without a replacement.
It’s also interesting that opposition to the ACA doesn’t appear to be connected to whether people have been adversely affected by the law, as opponents claim. In fact, 71 percent said they had not been impacted (54 percent) or had benefited (17 percent). Only 29 percent said they had been negatively affected.
In assessing attitudes about the ACA, it is important to look at the percentage of favorable opinions about some of the law’s most important provisions:
• 79 percent of Americans (and 73 percent of Republicans) support closing the Medicare Part D donut hole.
• 77 percent of Americans (and 65 percent of Republicans) support subsidy assistance to individuals.
• 77 percent of Americans (and 75 percent of Republicans) support no out-of-pocket-cost for preventive services.
• 74 percent of Americans (and 62 percent of Republicans) support the expansion of Medicaid.
• 70 percent of Americans (and 69 percent of Republicans) support the guaranteed issue of insurance coverage.
• 57 percent of Americans (and 36 percent of Republicans) support the employer mandate/penalty.
At this point, this is probably the most telling poll number: More than half of all Americans (53 percent) say they are tired of the debate over the ACA and want the country to focus on other issues; 42 percent want the debate to continue.
Claim: People are now uninsured because their plans are being canceled
Many Americans received notices that their insurance plans would not be renewed in 2014. In most cases, policies were not renewed because they did not meet ACA coverage requirements. Opponents characterized “non-renewal notices” as “cancellation notices.”
In fact, because of the health care law, insurance companies can no longer cancel coverage outright and leave a person or family uninsured. Insurance companies must now offer alternative coverage, and many Americans have chosen to enroll in new and more comprehensive plans. Others have chosen to purchase coverage through the health insurance marketplaces. For many, that coverage was more affordable due to the tax credits and subsidies.
It’s also important to remember that, long before the ACA, companies routinely discontinued individual insurance plans. A study tracking coverage in the individual insurance market from 1996 to 2000 found that only 17 percent of people kept their coverage for more than two years. In fact, the median length of coverage was eight months.
Before the ACA, individual insurance plans often limited the benefits they offered, imposed annual and lifetime spending caps and increased out-of-pocket costs for policyholders in order to keep premiums and claims low. Under the ACA, insurance companies can no longer offer low-quality, limited-benefit plans, impose cost caps or drop coverage because of health status.
Policy non-renewals/cancellations may also be less widespread than some opponents claim. A study released last week by the Rand Corp. estimates that fewer than 1 million people whose plans were not renewed lost insurance or could not replace it. The same study estimates that 9.3 million Americans gained coverage.
Claim: Under the ACA, you won’t be able to keep your doctor
The ACA says nothing about patients and their doctors. There are no provisions in the law that require a person to pick a new doctor, force doctors to keep patients or force an insurance company to keep or add doctors to a provider network.
Those decisions have always been a matter between insurance companies and doctors. Insurance companies frequently make changes to provider networks in order to keep down costs, increase profits or improve service. Those decisions are made as insurance companies manage costs.
Also, doctors and other providers may change networks in order to improve their reimbursement rates or services. Doctors are also free to decide whether they will continue to see Medicare patients or expand the number of Medicare patients that they currently treat.
Claim: Medicare will be severely cut under the ACA
Under the law, traditional Medicare benefits cannot be reduced and Medicare premiums and co-pays cannot be increased to pay for ACA reforms. Rather, under the new law, Medicare beneficiaries can now receive a number of preventative services without out-of-pocket costs, and the Medicare Part D donut hole will be closed by the year 2020.
The government will continue to spend a significant percentage of the federal budget on Medicare. What the ACA does is reduce the projected growth in Medicare spending by about $716 billion between 2013 and 2022. That spending reduction will focus on reimbursements to hospitals, insurance companies that offer Medicare Advantage plans, nursing homes and home-health-service providers.
As a result, Medicare’s solvency has been extended from 2016 to 2026. This may explain why budget proposals passed repeatedly by the U.S. House of Representatives leave those reductions entirely in place. None of the Republican alternatives to the ACA scales back these reductions.
Claim: Under the ACA you pay more and you get less
Before we blame the ACA for all future premium increases, it’s important to point out that insurance premiums have increased every year in recent American history. And the real culprit is not the ACA but the growth in health care costs. Thanks to the cost of health care, between 1999 and 2009, overall health insurance premiums grew by 131 percent. However, premiums are expected to increase at a slower rate under the ACA than if the law were repealed, according to the Congressional Budget Office.
MIT economist Dr. Jonathan Gruber, one of the architects of the Massachusetts health care reform effort, has stated that approximately one-half of Americans in the individual insurance market will pay more because their previous plans are no longer compliant with the ACA benefits provisions. The remainder should see no significant rate increase. The Centers for Medicare and Medicaid Services estimates that about 11 million people who have coverage through a small employer may see an increase, while 6 million people in that market may see a reduction.
The drafters of the Affordable Care Act anticipated many of these rate increases and implemented subsidies for people with incomes up to 400 percent of the federal poverty level. The drafters also created caps on out-of-pocket costs.
As for “getting less,” that’s what many Americans got previously, when many policies offered limited benefits and had holes in coverage that could wreck a family. Under the ACA, all policies must cover “10 essential benefits.” Should people face a serious health issue, the likelihood of severe financial damage or outright bankruptcy will be far less likely than under the old health insurance policies previously sold in the U.S.
But what may be most important is that millions of uninsured Americans now have access to coverage. According to a Gallup poll released this month, the number of uninsured Americans is lower than it has been in six years, dropping from an all-time high of 18 percent in 2013 to 14.5 percent at the end of March.
The bottom line is that, as stated in the Rand Corp. study, 9.3 million Americans gained insurance from last September through mid-March – and that doesn’t count the surge at the end of the month.
That’s a number you won’t be hearing in opposition ads.
Bob Semro is a health care policy analyst with the Bell Policy Center, a non-partisan policy research center that advocates public policies that reflect progressive values.
Opinions expressed in Health News Colorado represent the views of the individual authors.