Want to test your knowledge of the provisions, justifications, and implications of the Affordable Care Act? I’ve made it simple for you. Just answer the following yes-or-no questions, check against the correct answers, and read down to the end of this column to see what your score means.
Here are the questions:
1. Did the Democratic designers of the Affordable Care Act seek to rely primarily on private health insurance rather than a single-payer (government) plan to reduce the ranks of the uninsured?
2. Did North Carolina’s decision not to expand Medicaid under the ACA leave 500,000 people without access to health insurance?
3. Would Obamacare’s Medicaid expansion save money by reducing the extent to which uninsured people use expensive emergency-room care?
4. Is uncompensated care provided by hospitals to uninsured patients a major driver of health care inflation in the United States?
5. Will the Affordable Care Act reduce the future rate of growth in health care expenditures?
6. President Obama frequently promised that under the ACA, “if you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.” Is that true?
7. In response to recent news of hundreds of thousands of policy cancellations for people who buy health plans in the individual market, the Obama administration now says that the risk of cancellation won’t apply to the rest of the private insurance market — to those who get their health plans at the workplace. Is that true?
8. President Obama frequently predicted that the ACA would “lower health insurance premiums by up to $2,500 for a typical family per year.” Is that true?
9. Defenders of Obamacare said that it will reduce the federal budget deficit over time. Is that true?
10. Software and administration headaches have obviously discouraged enrollment in private health plans on federally run insurance exchanges. But Obamacare defenders point to state-run exchanges as successful at signing up many consumers for new private health plans. Are they right?
Here are the correct answers to the questions:
1. No. Although Obamacare’s insurance exchanges, taxes, and regulations applied to private plans have gotten the lion’s share of political and media attention, expanding Medicaid was always the law’s primary focus. More people were originally projected to sign up for Medicaid than to obtain private coverage. If enrollment problems persist for private insurers on the exchanges, government-run insurance will play a far more lopsided role than originally projected.
2. No. Although some analysts projected that as many as 500,000 North Carolinians might sign up for an expanded Medicaid program, that never meant they would be uninsured without Medicaid expansion. Some of them are already privately insured now. Because Medicaid wasn’t expanded, at least a third of them, with incomes between 100 percent and 138 percent of the poverty line, are now eligible to enter the insurance exchanges, usually with full federal subsidy. Practically speaking, those between 90 percent and 100 percent of poverty can also enter the exchange, since the Obama administration has said it won’t attempt income verification for those within 10 percent of the cutoff. In short, a high-bound estimate of the number of North Carolinians left uninsured would be about 320,000. The N.C. Department of Health and Human Services puts the number at closer to 150,000.
3. No. Most studies show that Medicaid recipients visit emergency rooms much more frequently than uninsured people do. Even the few studies with different results never find that Medicaid recipients visit ERs less frequently. This is one of the oddest claims that Obamacare defenders make, as it has been thoroughly and repeatedly refuted.
4. No. While unpaid bills are a major concern for some hospitals, they represent less than six percent of total hospital expenditures in the U.S. and something in the neighborhood of 3 percent of total health care spending. In short, they don’t come close to explaining health care inflation or justifying massive new federal regulations, taxes, or entitlements.
5. No. The Center for Medicare and Medicaid Services has released a 10-year projection of health care spending with and without the ACA. It projects that Obamacare will increase the nation’s health care spending by $621 billion.
6. No. Millions of Americans have received or will soon receive letters from their insurance carrier informing them that their plans are being cancelled due to Obamacare’s regulatory restrictions. I actually received such a letter more than three years ago, as my former insurer determined that the new rules would make it impossible to stay in the market.
7. No. Although the current wall-to-wall press coverage of policy cancellations is devoted solely to the individual market, keep in mind that while the individual mandate is currently in force for 2014, the employer mandate was delayed until 2015. Millions of additional Americans enrolled in employer-based health plans are likely to see their plans significantly altered or abolished over the next couple of years, either because the plans are noncompliant or because employers can no longer afford compliant coverage and will send their employees into the exchanges. How many? According to an analysis by the Obama administration itself, a mid-range estimate of the number of employer-based health plans that will lose grandfathered status is 51 percent.
8. No. Because the ACA imposes new taxes and mandates, increases regulatory compliance costs, and encourages more health care spending, average premiums will rise dramatically for many households. The math is inescapable. Apparent premium reductions for some households will occur, but this will reflect a tax-code redistribution of income, not an actual reduction in the cost of care or insurance.
9. No. Obamacare will widen the federal budget deficit. Estimates vary, but one realistic scenario pegs it as $500 billion more in deficit spending over the first decade and $1.5 trillion during the second decade.
10. No. The vast majority of enrollments to date in state-run exchanges have been for Medicaid, not private plans. For example, the much-touted Oregon state exchange signed up a grand total of zero individuals in private plans in October. This matters because unless a significant number of low-cost, premium-paying customers enroll in private exchange plans, they will quickly become unsustainable.
Compute the share of questions you got right. If you scored 80 percent or more correct, congratulations — you are an informed citizen. If you scored 60 percent to 80 percent correct, congratulations — you have demonstrated a healthy skepticism about the claims of politicians. And if you failed the quiz, congratulations — you are qualified to work as an administration flak, media stenographer, or liberal health policy analyst.
Hood is president of the John Locke Foundation.