Remember When 93 Million Health Care Plans Could Be Canceled?

Prior to the full implementation of Obamacare in 2014, Avik Roy estimated that 93 million health care plans could be cancelled due to the grandfather provision in Obamacare.  His analysis was not just political trash talk.  It was based on the Obama administration’s own report in the Federal Register.

In the Federal Register of June 17, 2010, the Obama administration provided a mid-range estimate that

66 percent of small employer plans and 45 percent of large employer plans will relinquish their grandfather status by the end of 2013.

Grandfathered plans are plans purchased before the passage of Obamacare that do not meet the standards required by Obamacare.  Individuals can keep these plans as long as the insurance company does not make any changes to the plan.  If the company does make changes, and the changes do not meet the Obamacare standards, the plan becomes illegal, and the individual is required to purchase an Obamacare qualified plan. 

After the passage of Obamacare, it was expected that over time all grandfathered plans would be converted to Obamacare qualified plans.  The major political question at the time was how long this would take.

Based on the mid-range estimate in the Federal Register, and figures from the Congressional Budget Office (CBO) that 156 million Americans were covered by employer-sponsored plans, Roy estimated that more than half of employer-sponsored plans would lose their grandfather status by the end of 2013, and that about 78 million employer-sponsored plans could be cancelled.

He also estimated that another 25 million people could lose coverage based on the administration’s projection that 40 to 67 percent of individual policies would lose grandfather status by the end of 2013.  The combined loses totaled 93 million policies. 

When this information became public, it caused political shockwaves. The public had no idea that Obamacare would affect so many policies so soon.

So, what happened?  The 93 million cancellations did not materialize by the end of 2013. The best evidence is that about 6 million cancellations occurred.

We can conclude from the facts that the Obama administration itself had no idea what the actual number of insurance cancellations would be.

We also know that Obama himself lied 29 times when he said that if you like your doctor you can keep you doctor, and we know that he lied about his own mother being denied health insurance, and we know that he lied about Obamacare not adding one dime to the deficit.

We also know that the Supreme Court ruled that the Obamacare mandate is a tax, even though Obama himself explicitly claimed that it was a penalty (here,) and we all know that Obamacare architect Jonathan Gruber said that the stupidity of the American voter was critical to getting Obamacare passed (here.)

In the final push to pass Obamacare, Nancy Pelosi’s claim that “We have to pass the bill so that you can find out what’s in it” became the zeitgeist of Democrat politics.  Just shut up and pass the bill.  We can’t wait.

In short, Obama and his acolytes were willing to say anything to gain government control of the means of production in healthcare. Most of what they said was either willful obfuscation or ignorant speculation.

Now, the shoe is on the other foot.  Republicans are pushing hard to change the law and Democrats are in a frothing rage.  Never mind that the Republican effort may actually cement in place the government takeover of American healthcare.  Never mind that Obamacare is collapsing.  Never mind what is actually happening.  Republicans must be stopped!

And, true to form, the Democrat opposition has rolled out its big guns to wage another war of obfuscation and lies to save Obamacare.  The breathless lame stream media can’t resist a doomsday headline, and even the right wing media wants in on the apocalypse.

The rolling thunder against repeal and replace began last fall.  On November 9, VOX claimed that 22 million would lose insurance under the Republican plan.  Later in November, Paul Krugman estimated that 5 ½ million “Trump chumps” voted themselves out of healthcare.  By December 11, NBC was reporting the results of an Urban Institute study claiming that 30 million would lose coverage, and that the total number of uninsured people would rise to 59 million by 2019.  In January, The Washington Post and Fortune magazine reported CBO numbers that 18 million would lose insurance in the first year of repeal, that 32 million more Americans would be uninsured by 2026, and that premiums would double by 2026.  In March, CNN quoted an S&P Global report and claimed that 10 million would lose coverage.  Also in March, a Forbes report claimed that 15 million fewer people would be covered under the Republican replacement plan.  In May, the CBO estimated that 23 million more people will be without insurance by 2026.  And, to top it off, in March, Breitbart reported that hospitals are projecting millions in lost revenue under the Republican plan.

But wait, there’s more.  It’s not enough to say that millions of people will lose their insurance.  People must be told that losing their insurance will kill them.  In February, VOX proclaimed:

Repealing Obamacare could kill more people each year than gun homicides.  If 20 million people lose their insurance, 24,000 extra people will die (here.)

We’re not sure where the “extra people” in America live, but the headline assures us that 24,000 of them might die under the repeal plan.  Democrats are certain that Republicans are killing people.  Hillary Clinton believes it, and so does Elizabeth Warren.  In the mother of all estimates, Montel Williams believes that Republicans are going to kill 140 million people! 

(But please, I beg you, try to look on the positive side - - they might all be “extra people” who aren’t needed anyway.)

The opposition argument is quite simple: Obamacare insured 20 million more people than were insured previously, Republicans will take away that insurance, and without insurance some of those people will die because of it.

This argument, however, has been refuted in various publications.  The essential points are as follows.

In reality, there never was an increase of 20 million newly insured people due to the magic of Obamacare.  At best, about 11.8 million went on Medicaid, and another 2.2 million gained private coverage.  Therefore, any arguments based on the 20 million number are phony arguments.

Moreover, extrapolating deaths from lost insurance is not an exact science.  At National Review, Max Bloom recently published a cogent response to the hysterical death claims in current media coverage.  He concluded:

In short, the only problem with the estimate that Obamacare repeal will kill tens of thousands is that it cherry-picks one study out of several, ignores the limitations of that study, assumes that private insurance and Medicaid are equivalent, assumes that losing health insurance and gaining health insurance are precisely symmetric, uses implausible estimates of coverage loss, and relies on an idiosyncratic definition of the word “kill.” Otherwise, it’s fine.

At the Manhattan Institute, Oren Cass has published an even more in-depth analysis of the claim that repealing Obamacare will kill people, and has come to an even more radical conclusion:

The practical effect of the Affordable Care Act has been to expand the non-elderly adult population covered by Medicaid. Unfortunately, we know from numerous studies that such Medicaid expansions do not improve public health. Mortality data from the last several years indicate that the ACA has done no better. The best statistical estimate for the number of lives saved each year by the Affordable Care Act (ACA) is zero.

If Obamacare saves zero lives each year, then there is no statistical pool of “saved lives” that is going to revert to “lost lives,” or people killed by Republican replacement efforts.

Cass summarizes his key points as follows:

A statistical claim that the ACA saves large numbers of lives should be supported by evidence that it has reduced mortality rates; yet the opposite occurred.

*In 2015, age adjusted mortality rose and life expectancy declined in the United States for the first time since the early 1990s.

*Nor is it the case that states adopting the ACA’s optional Medicaid expansion performed better than those rejecting it; to the contrary, mortality in 2015 rose more in Medicaid expansion states.

*Despite implementation of the ACA, there were 80,000 more deaths in 2015 than had mortality continued to decline during 2014-15 at the same rate as during 2000-2013.

In the coming week, you can be sure that Democrats won’t be shouting that Obamacare killed 80,000 people in 2015.

As the new Obamacare debate rages on, ignore the hysterical claims of lost insurance and rising death tolls.  The actual history of Obamacare makes it abundantly clear that no one knows exactly how many people will lose insurance or gain insurance until it happens.  And no one knows exactly how many more people or how many less people will live or die until the data are in.  And no one has a magic formula for converting the number of insurance policies to the number of people saved or killed.

Instead, follow the money.  Who benefits?  Who controls?  Is your healthcare yours to decide?

James G. Robertson is a biochemist and University of Virginia alumnus.