Obamacare: Sicker Than We Thought

For far too long, opponents of the Affordable Care Act focused on a malfunctioning website, which is akin to complaining that a guillotine's blade isn't sharp enough.  The process doesn't really matter, if folks end up with their heads on platters.

Even as Barack Obama does a NASCAR-like victory lap, claiming 8 million enrollees (Full disclosure: the author is one of the folks who have health insurance through the exchange.  Or maybe he's six people, having had to fill out an application several times to get through the enrollment process.), there are ominous portents for his multi-trillion-dollar "signature" program.  Mr. Obama might want to check the lug nuts before he spins another donut.

Early reports show that folks signing up for health insurance through ACA exchanges are less healthy than expected, and that the high cost of medications they'll need will put additional strains on the ACA's unrealistically optimistic budget. 

Consensus has been that, for the exchanges to work, not only young, but young and healthy folks would have to sign up in hefty numbers, paying for the needs of the less healthy.  That apparently isn't happening.

Recent numbers from the Gallup Organization show that only 37% of folks signing up for new insurance on the exchanges reported that they were in excellent or very good health, compared to 50% of the general public.

Gallup's numbers are backed up by a report in the Inside Health Exchanges industry newsletter.  "Based on preliminary pharmacy data from two large pharmacy benefit managers (PBMs), exchange enrollees appear to be less healthy than are people covered by individual policies sold outside of the exchanges. And that could translate to more costs for carriers once those members reach their out-of-pocket maximums."

The Inside Health Exchanges (HEX) report continued:

During the first two months of 2014, exchange enrollees were more likely to use costly specialty drugs when compared to those with coverage outside of the exchanges, according to preliminary claims data released April 9 by Express Scripts. The analysis evaluated 650,000 pharmacy claims for public exchange enrollees and other commercial members from Jan. 1 through Feb. 28. According to the early data, six of the 10 costliest medications used by exchange enrollees were specialty drugs versus four of the top 10 used by commercial health plan enrollees….

...Prime Therapeutics has seen similar results. Compared to its commercial book of business through February, the PBM says new individual enrollees had twice as many 90-day prescriptions as would be expected in an average commercial book of business…

...While people with chronic and complex conditions were expected to enroll in coverage through the exchanges, (Express Scripts vice president of healthcare) Julie Huppert tells HEX the early prescription drug usage was higher than anticipated.

Or, as Gallup notes:

The intent of the individual mandate, broadly speaking, was to bring healthy people -- with their lower probability of needing to use their insurance -- into the healthcare system. A strong skew among the newly insured toward healthier Americans has apparently not yet materialized.

Thus, early indications are that the health of, and subsequent costs for, exchange enrollees are worse than anticipated.

In addition to being less well, literally, Gallup's research indicates that those who got new health insurance through the exchanges are also less well off financially, with almost 42% reporting an income of $24,000 a year or less, meaning higher spending on tax credits to pay for the policies.  It also calls into question the enrollees' ability to pay the higher premiums resulting from ACA requirements.

Further, despite the potentially astronomical costs, the ACA is making only marginal improvement on its stated goal of reducing the number of uninsured.  Gallup's numbers confirm that relatively small percentages of folks getting new health insurance this year did not already have coverage.

Among people who said they have new policies this year, Gallup reports that only one-third didn't have insurance last year.  Which means that fully two thirds of folks who have new policies already had health insurance.  And even among the one third with new insurance, many got coverage through, as Gallup notes, "employee policies, Medicaid, and other private policies."  A small percentage even included folks 65+ who went from no insurance to, presumably, Medicare coverage.  And millions of people were added to the rolls of Medicaid and the government's Children's Health Insurance Program through ACA expansion.

Gallup's research supports an earlier RAND study that showed that only one third of exchange enrollees didn't already have insurance, but RAND's results were discounted by the Obama propaganda machine – often called the legacy media – because of its small sample size.  Gallup's numbers come from its daily tracking survey of 20,000 people conducted between March 4 and April 14.

The Gallup survey indicates that, overall, 4% of respondents said they have gone from no health insurance to having coverage this year: 2.1% through government exchanges, 1.9% through other means.  But some of that can be explained by modest increases in employment.  Indeed, Gallup also shows that the percentage of uninsured has still not dropped to pre-Great Recession levels.

Further, we may never know the fully disruptive impact of the ACA.  Gallup is either not tracking or not reporting how many people actually lost insurance because of the ACA.  Gallup says about its recent survey, "[T]he calculation of the newly insured does not take into account those who may have been insured in 2013 but not in 2014."

And the Census Bureau, which the Obama administration hijacked and dragged into the White House, making it potentially a house organ, like MSNBC, has announced that it's changing the way it questions folks about their health insurance status.  That means, no matter the reality, Census Bureau statistics will show a drop in the number of uninsured.  "We are expecting much lower numbers just because of the questions and how they are asked," Brett J. O’Hara, chief of the health statistics branch at the Census Bureau, told the New York Times.

That much has been widely reported.

What has been little noted is the Times' statement that "the agency was not planning to release coverage data from early this year in its next report," which would normally be in September.

Thus, no data on health insurance coverage will be available to the public until well after this fall's elections.

That scraping taxpayers hear?  It's the sound of a guillotine blade being sharpened.

William J. Tate is a former award-winning journalist.

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