Debunking the ‘20 million’ ObamaCare myth

Democrats’ last-ditch efforts to save the Affordable Care Act from Republicans’ repeal-and-replace plans have devolved into a single specious claim: The number of Americans who now have access to quality health insurance has risen by upwards of 20 million, thanks to the reforms ushered in by the ACA. Any attempt at replacing existing ObamaCare exchanges with a more free-market system, ACA supporters argue, would put these 20 million people in grave danger.

The “20 million” claim, while often repeated, is a mythological political creature of the worst sort. Supported by absolutely no hard data at all, it ought to conjure up the same kind of scoffs serious scientists mutter when well-meaning travelers seek to prove the existence of Bigfoot or the Loch Ness Monster.

{mosads}At a recent House Budget Committee meeting on the “failures of ObamaCare,” Ed Haislmaier, a Heritage Foundation senior research fellow, explained only about 14 million gained health insurance from 2014 to 2015. Preliminary data for 2016 reveal “enrollment in the individual market grew by 842,028 individuals, enrollment in fully insured employer plans declined by 1,128,597 individuals, enrollment in self-insured employer plans increased by 776,780 individuals, and Medicaid and [Children’s Health Insurance Program] enrollment increased by 2,044,809 individuals,” Haislmaier said.

The roughly 2.5 million people added in 2016 brings the total number of Americans who have gained access to health insurance to 16.5 million, well below the alleged “20 million” slogan Democrats have made into their rallying cry. But even this figure paints a wildly inaccurate picture of the alleged benefits of the ACA.

Utterly false is the claim the number of Americans who have gained health insurance is due to the effectiveness of the ObamaCare exchanges to offer quality health insurance at a reasonable cost. The truth is whatever gains have occurred since the ACA was passed should be attributed to the growing Medicaid population.

According to Haislmaier’s congressional testimony, “Medicaid accounted for 81 percent of the incremental growth in enrollment in 2016—a ratio consistent with the experience during the previous two year’s of ACA implementation.”

In line with Haislmaier’s claims, a comparison of the Congressional Budget Office’s baseline reports for Medicaid show enrollment in the program has risen dramatically compared to pre-ACA estimates. In 2009, CBO projected average monthly enrollment in Medicaid and CHIP in 2016 would be 58.3 million. In CBO’s most recent report, released in January, it reported average monthly enrollment exceeded 76 million in 2016, a 30 percent increase over the 2009 estimate.

Medicaid benefit payments also differed substantially. CBO’s 2009 projection for 2016 was $317.5 billion, but CBO’s 2017 report indicates $337 billion in Medicaid benefit payments were made in 2016.

Even the Centers for Medicare and Medicaid Services admits Medicaid is hemorrhaging 49 percent more money under ACA than CMS projected it would just 18 months ago. “[T]he estimated per enrollee costs for 2015 in this year’s report are substantially greater ($6,366 compared to $4,281, or about 49 percent higher),” states the agency’s 2015 Actuarial Report on the Financial Outlook for Medicaid.

The same CMS report found the cost of insuring new enrollees made eligible for Medicaid by ACA actually increased 16 percent between 2014 and 2015—instead of decreasing by 22 percent, as CMS had predicted. Worse, at an average of $6,366 a pop, the Medicaid costs of this newly eligible (and presumably able-bodied) population was 23 percent more than the average Medicaid cost of $5,159 per non-newly eligible enrollee.

The one benefit consistently repeated by ObamaCare sycophants is really nothing more than a not-so-elaborate fiction, but where does the 20-million figure come from? Rather than utilize actual enrollment data, the Obama-led Department of Health and Human Services relied heavily in its reports on surveys and estimates, which it manipulated to control for “general economic conditions (i.e., employment status), preexisting trends, geographic location, and demographic changes …” according to a press release from HHS.

ObamaCare die-hards have similarly tried to bury the facts linking up to 81 percent of ACA’s so-called success to a Medicaid expansion agenda costing the country 49 percent more than CMS predicted.

“We should start calling this law SCOTUScare,” quipped the late Justice Antonin Scalia in his dissent in King v. Burwell (2015). We would do just as well to start calling this law Obamacaid. We would do even better by repealing it instead of mythologizing it. 

Justin Haskins is executive editor of The Heartland Institute and editor-in-chief of the New Revere Daily Press. Michael T. Hamilton is a Heartland Institute research fellow and managing editor of Health Care News.

The views expressed by contributors are their own and are not the views of The Hill.