With enrollment data through February 22, the administration finally declared Obamacare’s second enrollment season closed and released its report on the results. (Although, people who have to pay Obamacare’s mandate/penalty/fine/tax as a result of information disclosed in their 2014 tax returns will have a special open enrollment in April).
Obamacare’s supporters cheered that enrollment hit 11.7 million people, exceeding the low-ball estimate of 9.1 million the administration made last November. Lost in the enthusiasm for Obamacare’s new high-water mark are a few uncomfortable facts.
First, the average premium — net of subsidies — has jumped 23 percent from 2014. In both years, insurers covering almost nine in ten Obamacare subscribers received subsidies to reduce premiums. The average monthly premium, before insurers receive subsidies, across all “metal” plans, is $364 in 2015. The average subsidy is $263, resulting in a net premium of $101 (Table 6). In 2014, the administration reported an average premium of $346, less an average tax credit of $264, for a net premium of $82 (Table 2). Therefore, the gross premium increased 5 percent but the subsidy declined by a scratch. Due to the power of leverage, this resulted in subscribers seeing an average premium jump of 23 percent.
Second, Obamacare continues to “churn” peoples’ insurance coverage. Like last year, we can expect a significant share of this year’s 11.7 million enrollees will never pay a premium, often because they will receive employer-based coverage if they move up in the world, or fall into Medicaid dependency if they drop.
For the states using healthcare.gov, only 4.2 million of the 8.8 million 2015 enrollees were enrolled at the end of 2014. After Obamacare’s first open season closed, the administration reported that 5.4 million of the 8.1 million enrollees had signed up through healthcare.gov (Table 1). (That figure was later revealed as somewhat contaminated by the inclusion of standalone dental plans.).
So, over one fifth of those who were enrolled by April 2014 had vanished from Obamacare by February 2015. Maybe some of them did re-enroll for 2015: Someone could have signed up in April 2014, dropped out during 2014 and signed up again this time around. This fragmentation of coverage in working and lower middle-class households is surely frustrating to them and harms the quality of care.
Third, a loss for the administration in the Supreme Court’s King vs. Burwell lawsuit will deal a mortal blow to Obamacare. This is the lawsuit asserting what the Administration is paying out of subsidies to insurers in state-based exchanges is illegal. Of the 11.7 million new enrollees, 8.8 million enrolled through healthcare.gov and only 2.8 million through state exchanges. The Supreme Court is expected to make a decision by July. If the administration loses, three quarters of Obamacare beneficiaries will be in states in which insurers lose their subsidies. To resolve the resulting inequity between states, Congress will have to respond with amendments to the Affordable Care Act that President Obama will sign.
Third, Obamacare subscribers are less satisfied with their plans than beneficiaries of other government or private health plans are:
The 29 percent of re-enrollees who switched plans is higher than that seen in other programs. For example, studies show approximately 13 percent of Medicare Part D enrollees change plans in a given year; 12 percent of those active employees with Federal Employee Health Benefit Plan coverage switch plans each year and only about 7.5 percent of those with employer sponsored coverage switch plans for reasons other than a job change during a given year. (p. 6)
Fourth, both the Obamacare subsidies and the Affordable Care Act’s big increase in Medicaid spending are higher than necessary to get people covered. Although the average net premium jumped 23 percent, subscribers were nevertheless willing to pay up for a higher level of coverage. While 77 percent of the 7.65 million subsidized subscribers who used healthcare.gov could have bought plans for less than $50, only 38 percent did. While 89 percent could have bought plans for less than $100, only 63 percent did (Table 7). Obamacare subscribers have enough discretionary income to pay for health insurance and need not be so dependent on taxpayers.
This is strikingly apparent among low-income households, which are eligible for Medicaid in states that chose to expand that type of welfare. (Medicaid is a joint state-federal welfare program that provides health coverage.) Table 5 (page 14) shows the income distribution of households enrolling in Obamacare, broken down into states that did or did not expand Medicaid.
Two cells are highlighted: Households between 100 percent and 150 percent of the Federal Poverty Level (FPL) in states that expanded Medicaid dependency, and those that did not. Many of the latter would be in Medicaid if their states had expanded the program. In such states, only 47 percent of Obamacare enrollees are within this income range, versus only 22 percent in states that expanded Medicaid. This indicates that Medicaid expansion has trapped people into complete government dependency for health care, who would be able to buy private health insurance with some government subsidy.
Despite a successful headline number of subscribers, Obamacare is still deeply flawed.