It’s going to be a messaging war for the ages.
When some of the Affordable Care Act’s most critical features go into effect Oct. 1, so too will a massive struggle between the law’s advocates and allies, as supporters attempt to convince Americans that the law is helping them afford their insurance, while critics scramble to prove it’s sending insurance premiums skyward.
But as politicians pontificate and flacks flack, health care analysts are growing exasperated with a debate that is rapidly filling with faulty logic and fuzzy math.
“You can make those numbers look like almost anything you want,” said Caroline Pearson, vice president of the D.C.-based health care consulting firm Avalere Health. “It has been highly politicized topic.”
So, amid the spin, how should everyday Americans judge Obamacare’s success in controlling the cost of health insurance? Here’s step-by-step advice from the experts.
1. Don’t believe the hype.
The October kickoff will be followed by a flood of studies and press releases, most of which will cherry-pick data while claiming to render a “final judgment” on whether the law is making insurance more or less affordable.
But those should all be taken with a tablespoon of salt, as no single piece of evidence — nor even any single study — can provide a definitive answer, Pearson said.
“There’s not really a good way to answer the question. There’s no apples-to-apples comparison,” she said. “Is one product being sold today to one group of people going to be more or less expensive than a totally different product sold later to a totally different group of people? There’s no way to compare those two in a way that would be deemed fair.”
Rather than banking on a single study, understanding the law’s effects on insurance costs will require a sustained, broad look. And even then it will remain a matter of of ongoing contention — as neither camp is showing any signs of giving ground.
“I don’t think the proponents will ever admit it’s a failure,” said Devon Herrick, senior fellow at the National Center for Policy Analysis.
2. Forget your arithmetic, remember your calculus.
Unless there is a sudden and shocking break from the long-term trend, health insurance premiums will continue to rise after the law takes effect — but that by itself isn’t an indictment of the law.
Instead of lowering costs absolutely, the law’s immediate aim is to slow the rate at which they are increasing, moving the rate closer to the rate of inflation. And it’s by that metric that the law’s insurance costs effects should be judged, Pearson said.
Moving toward the pace of inflation would be a major improvement from the past decade. Average premiums for family coverage rose by 80 percent and single coverage by 74 percent, according to the Kaiser Family Foundation’s survey about employer-sponsored insurance coverage.
Although the rate of growth has slowed in recent years, premiums are up nearly 5 percent from last year for single coverage and nearly 4 percent for families. The growth outpaces wage earnings and inflation, which rose 1.8 percent and 1.1 percent respectively.
3. Ditch the God complex.
Despite what the Beltway crowd would have you believe, Obamacare won’t be the only factor driving insurance costs in the years to come. In many cases, it won’t even be the most important one. Instead, economics, demographics, and technology will often be in the driver’s seat.
Take, for example, a Kaiser study released last week that found that although premiums rose again in 2013, it was at a slower rate than was seen before the passage of the law. Obamacare backers were quick to credit the law, but the moderation in costs were at least partially driven by the Great Recession, Herrick said.
“As jobs became less stable, employers cut back on medical coverage first,” he said. “As the economy improves, you’ll see people who otherwise wouldn’t go to the doctor starting to use the system.”
Additionally, medical technology can also move the premium needle, Person said, noting that innovative new breakthroughs can improve health results while simultaneously increasing health costs.
And then there are the nation’s demographics, which are propagating a price bump that no law could interrupt: The baby boomers are getting old, moving a mass generation into the age range where more — and more-expensive — medical care is needed.
4. Don’t ignore “It depends.”
Coverage under Obamacare is not consistent. The upfront cost depends on which plan you select — and how much you use health care will determine your total annual expense.
The health insurance exchange has four tiers: bronze, silver, gold, and platinum.
The bronze plan offers the lowest premiums but the least coverage once a worker reaches the deductible and insurance kicks in. On the bronze plan, the provider covers 60 percent of the cost of care and the worker is responsible for 40 percent. This is, of course, after the worker has paid full out-of-pocket costs to reach the deductible.
So, if a worker has a healthy and safe year, out-of-pocket costs will remain low. Combined with the bronze plan’s lower premium, this is the most economical choice for those using Obamacare.
Silver, gold, and platinum plans raise premiums but also raise the level of responsibility for the provider to 70, 80, and 90 percent respectively, offering greater protection in expensive and unforeseen health emergencies.
In an ideal world, you’d be on the platinum plan the year you broke your leg and on the bronze plan every other normal and healthy year, giving you the most for your money. But the success of your insurance choice, like the success of Obamacare, is a gamble.
5. Remember Olive Garden … then forget about it.
Horror stories and tales of triumph have been regular features of the Obamacare debate, and they will continue to be going forward.
Conservatives were crowing earlier this year when restaurant CEOs — including top brass at Olive Garden and Applebees — said their chains would shed jobs and cut back hours because of the law’s regulations. And the law’s backers have not hesitated to do cherry picking of their own, repeatedly pointing to hard-luck individuals who suffered under the old health care regime and are already better off under the new one.
But while such anecdotes matter tremendously to the people involved, they are — when taken alone — a terrible basis for evaluating a national law that is set to affect nearly every facet of the American economy.
Like nearly every other law, the Affordable Care Act will have its individual winners and losers, but when it comes time for judgment, it’s the bigger picture that matters.
6. Patience, patience, and more patience.
Americans won’t get their answers on Obamacare any time soon, experts say.
Indeed, the White House decided recently to wait a year to enforce employers’ mandate to provide their employees health insurance, and the administration has turned back the clock on a key consumer protection: out-of-pocket expense caps.
Even after the law is implemented, its fate will be far from settled. For example, the efficacy of the state insurance exchanges — which Herrick called the biggest determining factor in the law’s success — will be determined largely by how successful they are in persuading people to enroll, especially young, healthy adults.
But while the law is still in its nascent stages, the doomsayers and cheerleaders have not — and will not — wait to make their case.
“I think the challenge is that people want to have something to weigh in on,” Pearson said, “and nothing has started yet.”
What We're Following See More »
Foreign Policy takes a look at the future of mining the estimated "100,000 near-Earth objects—including asteroids and comets—in the neighborhood of our planet. Some of these NEOs, as they’re called, are small. Others are substantial and potentially packed full of water and various important minerals, such as nickel, cobalt, and iron. One day, advocates believe, those objects will be tapped by variations on the equipment used in the coal mines of Kentucky or in the diamond mines of Africa. And for immense gain: According to industry experts, the contents of a single asteroid could be worth trillions of dollars." But the technology to get us there is only the first step. Experts say "a multinational body might emerge" to manage rights to NEOs, as well as a body of law, including an international court.
Not to be outdone by Jeffrey Goldberg's recent piece in The Atlantic about President Obama's foreign policy, the New York Times Magazine checks in with a longread on the president's economic legacy. In it, Obama is cognizant that the economic reality--73 straight months of growth--isn't matched by public perceptions. Some of that, he says, is due to a constant drumbeat from the right that "that denies any progress." But he also accepts some blame himself. “I mean, the truth of the matter is that if we had been able to more effectively communicate all the steps we had taken to the swing voter,” he said, “then we might have maintained a majority in the House or the Senate.”
Ronald Reagan's children and political allies took to the media and Twitter this week to chide funnyman Will Ferrell for his plans to play a dementia-addled Reagan in his second term in a new comedy entitled Reagan. In an open letter, Reagan's daughter Patti Davis tells Ferrell, who's also a producer on the movie, “Perhaps for your comedy you would like to visit some dementia facilities. I have—I didn’t find anything comedic there, and my hope would be that if you’re a decent human being, you wouldn’t either.” Michael Reagan, the president's son, tweeted, "What an Outrag....Alzheimers is not joke...It kills..You should be ashamed all of you." And former Rep. Joe Walsh called it an example of "Hollywood taking a shot at conservatives again."
In a sign that she’s ready to put a longer-than-expected primary battle behind her, former Secretary of State Hillary Clinton (D) is no longer going on the air in upcoming primary states. “Team Clinton hasn’t spent a single cent in … California, Indiana, Kentucky, Oregon and West Virginia, while” Sen. Bernie Sanders’ (I-VT) “campaign has spent a little more than $1 million in those same states.” Meanwhile, Sen. Jeff Merkley (D-OR), Sanders’ "lone backer in the Senate, said the candidate should end his presidential campaign if he’s losing to Hillary Clinton after the primary season concludes in June, breaking sharply with the candidate who is vowing to take his insurgent bid to the party convention in Philadelphia.”
The team behind the bestselling "Clinton Cash"—author Peter Schweizer and Breitbart's Stephen Bannon—is turning the book into a movie that will have its U.S. premiere just before the Democratic National Convention this summer. The film will get its global debut "next month in Cannes, France, during the Cannes Film Festival. (The movie is not a part of the festival, but will be shown at a screening arranged for distributors)." Bloomberg has a trailer up, pointing out that it's "less Ken Burns than Jerry Bruckheimer, featuring blood-drenched money, radical madrassas, and ominous footage of the Clintons."