The Senate plan means 22 million uninsured? Let’s take a honest look at that number

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Senate Republicans have announced that they are delaying a vote on their health care plan by at least a week. The news comes after several Senators had second thoughts because a report from the Congressional Budget Office suggested that under the GOP plan 22 million people would not have health insurance.

The U.S. Bishops cited the 22 million figure as “simply unacceptable” in a press release attacking the GOP plan. The brief USCCB statement came from Bishop Frank Dewane of the Diocese of Venice, who heads the conference’s “Domestic Justice and Humane Development Committee.”

The focus of Bishop Dewane’s statement is on CBO’s coverage estimates. According to the scorekeeper’s report, 22 million Americans will lose health insurance coverage under BCRA. Understandably, such a decimation of basic health insurance coverage would create a public policy crisis and the bishops are right to be sensitive to it.

But what Bishop Dewane might not realize, the CBO has a horrible record of estimating coverage changes under health care legislation — as health policy experts like Avik Roy, Doug Badger, and Grace-Marie Turner have all pointed out. As President Trump cited last night, the CBO originally thought 30 million Americans would gain coverage by now under Obamacare, when the actual number is 22 million–a full 8 million short.

Additionally, Avik Roy points out that CBO came up with nearly identical coverage numbers for Obamacare repeal with no replace (24 million new uninsured), Obamacare repeal with the House version of replace (23 million uninsured), and Obamacare repeal with the Senate version of replace (22 million uninsured).

In other words, the CBO would have us believe spending over $600 billion in a decade to buy people insurance results in the same coverage numbers as spending $0 on people.

That’s absurd. And it should cause any CBO coverage numbers to be dismissed, without irony, as fake news.

The reason these coverage numbers keep coming out the way they do is because the CBO is staffed by health policy experts hired by Democrat-appointed CBO directors during the run-up to Obamacare. They in turn developed a coverage model highly dependent on the much-hated individual mandate and which assumes that most states will expand their Medicaid populations.

In fact, fully 15 of the 22 million new uninsured arise under the CBO’s model solely due to the repeal of the individual mandate–meaning people are choosing voluntarily to not buy a product when the government stops forcing them to.

Having a better command of facts like these could help the Bishops craft statements that illuminate the debate, rather than needlessly inflame it.

So what should an informed Catholic think about the bill?

The first answer is that this is an area, almost by definition, of prudential judgment. A Catholic lay healthcare expert in good conscience can be for single payer health care, HSAs for all, or almost anything in between. More politically liberal Catholics seem to think they have a monopoly on turning Catholic social doctrine into law, but that’s simply not true. There is a wide range of ways to, in good conscience, live out the social teachings of the Church in the area of public policy. The Church–and especially the clergy, to avoid the hated moniker of “clericalism”–should really respect the freedom of the expert laity to do so.

Another consideration is the status quo. Obamacare is absolutely failing for millions of people. According to the Department of Health and Human Services, some 1200 counties in the United States will have one or zero health insurance providers in their individual markets in 2018. That’s 40 percent of the counties in the whole country. These are people who need access to much better and more robust health insurance markets than they have today.

Then there are the poor. There are 3 million Americans who live below the poverty line, but who do not qualify for Medicaid in their state. Obamacare does nothing for them, as the tax credit starts above the poverty line level. In other words, the Americans who most need help purchasing health insurance get no help at all.

Even for those who can get health insurance, it is increasingly unaffordable for families (especially families who are generous and open to the gift of life). In Virginia’s northern suburbs, the least expensive plan for a typical family of four has premiums of $12,000 and a deductible of over $8000. This plan is being dropped in 2018, and any new insurance plan is likely to have even higher premiums and deductibles. This is simply not affordable for families who don’t make multiple six-figure salaries.

Where’s the solidarity with these people? Shouldn’t the USCCB be focused on the people hurting today under Obamacare, and not the obviously flawed projection numbers of government bean counters? What about the Catholic families who live in one of the 1200 counties with zero or one insurance company? What about the Catholic families living below the poverty line and given no help with their health insurance costs? What about the Catholic families who can’t afford coverage after paying the bills and raising all the kids they vowed on their wedding day that they would accept lovingly from God?

BCRA is not a perfect bill, but it addresses all of these areas. It stabilizes insurance in the short term, bringing back multiple providers to these 1200 counties and stopping that number from growing. It for the first time extends health insurance subsidies–generous ones–to families living below the poverty line. It sets up a system where states can better tailor their individual markets and lower premiums for families. It gives states resources to establish mechanisms like chronically ill pools and reinsurance to further lower costs. It for the first time puts Medicaid on a sustainable fiscal path while turning over administration of the program to the states.

The theme of BCRA, actually, is the dual Catholic social justice goals of subsidiarity and solidarity. Means are provided to help states cover poor and working class people, but states are also given more latitude and responsibilities in this regard. States are the appropriate innovators here, and have the best and closest interaction with people who most need the help.

The alternative to passing BCRA is a continuation of the failures we have seen in Obamacare, and that will continue to hurt millions of families. More counties will become health insurance deserts. The poor will continue to have neither Medicaid nor subsidies in many states. The Catholic child-rearing middle class will get more and more priced out of having insurance at all.

It’s time that Bishop Dewane and the USCCB took a more nuanced view of this issue. The facts are there.

The views expressed here are those of the author, and do not necessarily represent the views of CatholicVote.org

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Ryan Ellis writes about politics and policy for Forbes. He's also an avid New England Patriots fan.

6 Comments

  1. “In fact, fully 15 of the 22 million new uninsured arise under the CBO’s model solely due to the repeal of the individual mandate–meaning people are choosing voluntarily to not buy a product when the government stops forcing them to.”

    I would LOVE a source for this statistic. Not that I doubt it, but if asked I’d like to be able to back it up.

    • The CBO report does confirm this, but it doesn’t confirm that it is a good thing like the author makes it out to be.

      “CBO and JCT estimate that, in 2018, 15 million more people would be uninsured under this legislation than under current law —primarily because the penalty for not having insurance would be eliminated.”

      https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf

      The people leaving the market are primarily young, healthy people.  Only in a fantasy world does health insurance become cheaper when healthy people leave the market.  The entire point of the market is predicated on shared risk.  Young healthy people pay in but don’t use a lot of care, and that balances the cost for those who need a lot of care.  This bill turns the entire concept on its head.  By allowing the healthy to leave the market AND by no longer mandating that all insured must pay for essential health benefits, those who need the essential health benefits – like maternity care – will simply bear the brunt of the cost on their own.  The CBO report bears this out, detailing how in states that waive the essential health benefits, about half the population will either be forgoing care or facing huge out-of-pocket costs.

      “Out-of-pocket spending would also be affected for the people—close to half the population, CBO and JCT expect—living in states modifying the EHBs using waivers. People who used services or benefits no longer included in the EHBs would experience substantial increases in supplemental premiums or out-of-pocket spending on health care, or would choose to forgo the services.”

      Do we really think the best model for health care is for the sick to pay for it?

  2. Your headline is kind of ironic, since this piece is full of dishonesty.

    “As President Trump cited last night, the CBO originally thought 30 million Americans would gain coverage by now under Obamacare, when the actual number is 22 million–a full 8 million short.”  No, that’s not accurate.  The CBO thought that 32 million Americans would no longer be uninsured, not specifically enroll in the Affordable Care Act exchanges.

    “CBO and JCT estimate that by 2019, the combined effect of enacting H.R. 3590 and the reconciliation proposal would be to reduce the number of nonelderly people who are uninsured by about 32 million, leaving about 23 million nonelderly residents uninsured (about one-third of whom would be unauthorized immigrants). Under the legislation, the share of legal nonelderly residents with insurance coverage would rise from about 83 percent currently to about 94 percent.”

    https://www.cbo.gov/sites/default/files/111th-congress-2009-2010/costestimate/amendreconprop.pdf

    This was actually largely accurate.  In the first quarter of 2016, the uninsured rate was 8.6%. The difference arises from the fact that states that refused Medicaid expansion increased the number of uninsured – which the CBO acknowledged in I its new analysis thereafter.

    https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201609.pdf

    https://www.cbo.gov/sites/default/files/112th-congress-2011-2012/reports/43472-07-24-2012-coverageestimates.pdf

    What the CBO got wrong was HOW people would be covered.  The CBO analysis thought that a greater number of businesses would end their group coverage and more people would enter the exchanges.  The CBO also didn’t factor in the Supreme Court decision TWO YEARS later and the subsequent decision by Republican governors to not expand Medicaid in their states.  Funny how you don’t mention that.

    “In other words, the CBO would have us believe spending over $600 billion in a decade to buy people insurance results in the same coverage numbers as spending $0 on people.”

    No, that’s patently false.  The uninsured rate went down from 17% to 8.6%.  Do you actually deny the CDC data?  Can you please provide your data?  You’re confusing the CBO estimate of the number of people on the exchanges and the number actually with insurance; those are totally disparate (obviously).

    “In fact, fully 15 of the 22 million new uninsured arise under the CBO’s model solely due to the repeal of the individual mandate–meaning people are choosing voluntarily to not buy a product when the government stops forcing them to.”

    Yes, you’ve quoted the number that fits your argument.  Sadly, you don’t provide THE VERY NEXT SENTENCE IN THE ANALYSIS.  “In later years, other changes in the legislation—lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market—would also lead to increases in the number of people without health insurance.”

    The people opting out of having insurance are primarily young, healthy people.  Can you explain why you believe this will help affordability in the insurance market?  This totally contradicts the very basis of insurance:  sharing risk.  If you take away the most profitable customers, won’t the insurance companies necessarily charge more?  Obviously, yes.  The CBO analysis says just that.  You just don’t cite it because it’s not convenient:

    “Some people enrolled in nongroup insurance would experience substantial increases in what they would spend on health care even though benchmark premiums would decline, on average, in 2020 and later years. Because nongroup insurance would pay for a smaller average share of benefits under this legislation, most people purchasing it would have higher out-of-pocket spending on health care than under current law. Out-of-pocket spending would also be affected for the people—close to half the population, CBO and JCT expect—living in states modifying the EHBs using waivers. People who used services or benefits no longer included in the EHBs would experience substantial increases in supplemental premiums or out-of-pocket spending on health care, or would choose to forgo the services. Moreover, the ACA’s ban on annual and lifetime limits on covered benefits would no longer apply to health benefits not defined as essential in a state. As a result, for some benefits that might be removed from a state’s definition of EHBs but that might not be excluded from insurance coverage altogether, some enrollees could see large increases in out-of-pocket spending because annual or lifetime limits would be allowed.”

    Fundamentally, the Senate and House bills place the brunt of the cost of health care on sick people.  Why is this logical, or consistent with Catholic teaching?

    https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf

    “Then there are the poor. There are 3 million Americans who live below the poverty line, but who do not qualify for Medicaid in their state. Obamacare does nothing for them, as the tax credit starts above the poverty line level. In other words, the Americans who most need help purchasing health insurance get no help at all.”

    Your dishonesty knows no bounds.  Gee, why does this situation exist?  It would have nothing to do with the fact that Republican governors refused Medicaid expansion – the very provision in Obamacare to help these people?  But no, let’s blame it on the bill itself.  That makes a lot of sense.

    http://www.kff.org/uninsured/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/

    “The alternative to passing BCRA is a continuation of the failures we have seen in Obamacare, and that will continue to hurt millions of families.”

    No, I’m pretty sure there are literally an infinite number of health care bills that could be written.  There are not just two choices.

    You claim you’re very focused on honesty.  Well, then provide the numbers that you believe are honest on the total number of uninsured under this bill.  That would be honest, right?

  3. Ryan Schroeder on

    Does the author, so focused on honesty, plan on posting here what he declares to be the accurate numbers on uninsured under this bill? It’s kind of ridiculous to declare the CBO numbers to be false, declare a mandate for honesty, and then post no numbers to support the argument.

  4. People, including bishops, keep confusing health insurance with health care. They are not the same. Health care will still be available as now. Only question is who will pay; taxpayer or patient or a combination. Also, different policies, not now permitted, will be available to those who think them suitable for themselves. For those who think they want a European system, I would advise that they look a little closer. Most Americans would not be at all satisfied with their programs especially long waiting lines and impersonal treatment and services. As far as the CBO, their track record with numbers is not encouraging, more so when politicians start tinkering with the legislative process.

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