Don’t Let the “Uninsured 20 Million” Statistic Fool You

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Twila Brase President, Citizens' Council for Health Freedom
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While I was on Capitol Hill recently encouraging full repeal of the Affordable Care Act (ACA), one question surfaced repeatedly: “What about the 20 million people who got coverage?”

Republicans are naturally concerned. Liberals have weaponized this number to stop repeal of the ACA. But should 20 million people keep a bad law on the books? To answer this question, Congress must ask two different questions.

First, is the number real? In March 2016, the Department of Health and Human Services (HHS) estimated that 20 million uninsured adults gained coverage under the ACA: 17.7 million non-elderly adults (ages 18 to 64) since October 2013, and 2.3 million young adults (ages 19-25) between 2010 and 2013.

The estimates are based on data from the National Health Interview Survey and the Gallup-Healthways Well-Being Index. The estimates are “adjusted to account for changes in general economic conditions (via employment status), geographic location, demographics and other secular trends.” Thus, the 20 million is an estimate, not a rock-solid fact.

Second, is the Affordable Care Act necessary for coverage?

Let’s examine the groups covered under the ACA, starting with Medicaid. Approximately 13 million additional people were expected to enroll in Medicaid in 2016 as a result of the ACA, according to the Congressional Budget Office. However, Forbes contributor Brian Blase, reflecting on a recent study by ACA architect Jonathan Gruber, says about 60 percent of these enrollees (7.8 million by my calculation) were eligible before the ACA expanded Medicaid. Their eligibility would continue even if the ACA is repealed.

The remaining 5.2 million, enrolled under the law’s Medicaid expansion, may not be continuously enrolled throughout the year. Due to eligibility criteria, recipients come and go as incomes rise and fall. Because Medicaid is a state program, but jointly funded by states and Congress, this group would not necessarily lose coverage if the ACA is repealed.

Prior to the ACA, six states expanded Medicaid eligibility. If the law is repealed, the other 44 states could expand eligibility, or if Congress provides states with Medicaid block grants, creative financing could be used to keep the ACA’s expanded eligibility criteria and benefits intact. For example, states could distribute lump-sum payments directly to hospital and clinic systems to care for Medicaid enrollees, bypassing the high costs of hiring managed care corporations to pay for care. Gov. Tim Pawlenty successfully did this in 2010 after the Minnesota-only General Assistance Medical Care program was repealed.

Let’s look at another group—the 5.9 million who lost their private insurance when it was prohibited by the ACA, forcing many into Obamacare coverage. If the ACA is repealed, this group will have access to the affordable coverage they once had and wanted to keep.

How about people with pre-existing conditions? Just 135,000 people enrolled in the ACA’s temporary Pre-existing Condition Insurance Plan. Another 226,000 people were previously covered by 35 state “high-risk pools.” States can resume responsibility for this group of high-cost individuals. For example, Alaska just established a high-risk pool for 500 chronically ill residents to prevent 23,000 Alaskans from facing 40 percent premium increases in the individual market.

Finally, consider the 2.3 million young adults who stayed on their parents’ policies because of the ACA. Most Americans don’t know that this provision cuts employee wages by approximately $1,200 per year. In reality, catastrophic coverage, unleashed from the ACA’s costly benefit mandates and regulatory requirements, would be more affordable for everyone.

In short, many ACA enrollees lost the coverage they liked because of the law, and most will continue to be covered once the law is repealed—at lower prices with more choices. Congress must not wait. Americans have lost doctors, hospitals and insurance options. Health plan consolidation has increased prices and restricted access to care. Employers have cut workers’ jobs, hours and wages. And insurance has become unaffordable.

As former president Bill Clinton said, “So you’ve got this crazy system where all of a sudden 25 million more people have health care and then the people who are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half. It’s the craziest thing in the world.”

Yes, it is. Crazy wrong. Repeal the law.

(Citizens’ Council for Health Freedom is a 501(c)3 national patient-centered national health freedom organization based in St. Paul, Minn., that exists to protect health care choices, individualized patient care, and medical and genetic privacy rights. CCHF sponsors the daily, 60-second radio feature, “Health Freedom Minute” and has branded “The Wedge of Health Freedom,” available to patients and doctors at www.JointheWedge.com. CCHF president and co-founder Twila Brase, R.N., has been called one of the “100 Most Powerful People in Health Care” and one of “Minnesota’s 100 Most Influential Health Care Leaders.”)