The president celebrated the 12th anniversary of the ACA, aka Obamacare, with his former boss last week. During the event, he used a number that has been a standard talking point for many Democrats. But the figure — that without the law, 100 million Americans could be denied health insurance — doesn’t tell the whole story.
It’s been a while since we’ve reviewed an ACA claim, so we thought it was worth explaining.
Every politician likes to claim that his policies benefit the greatest number. The 100 million figure has its roots in a study by Obama’s Department of Health and Human Services just before he left office in 2017. The study estimated that data from 2014 showed between 61 million and 133 million non-elderly Americans (23% to 51%) had a pre-existing medical condition that could have been subject to onerous Medicare rules.
“Any of those 133 million Americans could have been denied coverage, or offered coverage only at an exorbitant price, if they needed personal health insurance in the market before 2014” , said the HHS.
Note the reference to “individual” insurance. That’s because the ACA was primarily focused on the individual market – individual and small business policies sold on exchanges or directly to consumers – which is one-seventh the size of the job-based market where most Americans get their health insurance. According to the Biden administration, 11.3 million consumers were enrolled in ACA plans as of February 2021.
About 56% of Americans under 65 have health insurance through their employer. (People over 65 benefit from Medicare, the health care program for the elderly). plan.
This law, the Health Insurance Portability and Accountability Act (HIPAA) of 1996, rose from the ashes of President Bill Clinton’s failed efforts to provide universal health insurance. Today, HIPAA is best known for protecting the privacy of personal health data. But the “P” – “portability” in the title – refers to its provisions to ensure that employees would not lose their health insurance if they changed jobs.
“Even before the ACA, HIPAA offered strong protections for people with pre-existing conditions who accessed insurance through an employer,” said Larry Levitt, executive vice president of health policy at the Kaiser Family Foundation. “HIPAA limited the amount of time an employer plan could exclude coverage for pre-existing conditions to 12 months. It also required that any pre-existing condition exclusion be waived for people who had been covered continuously with no more than a short break. While employer plans were always allowed to impose a pre-existing condition exclusion for those not permanently covered, many employers did not do so anyway.
Levitt noted that Medicaid, the health insurance program for low-income workers, also does not deny coverage for people with pre-existing conditions before the ACA for those who qualified based on their income and other circumstances. . The ACA’s expansion of Medicaid eligibility to adults added 14.8 million people to the program as of December 2020, according to the administration.
Biden’s use of the 100 million figure appears to come from a 2018 estimate by Avalere Health, a consulting firm, as that was the quote the Biden campaign gave FactCheck.org in 2020. But that number included people who could have received health insurance but faced higher premiums or out-of-pocket costs due to a pre-existing condition.
“Our estimate of the number of adults with pre-existing conditions is lower because we focus on people with conditions that would have caused insurance to drop outright if someone had tried to buy it. on its own before the Affordable Care Act,” Levitt said. “We estimate that 27% of non-elderly adults have declinable pre-existing conditions, which is about 54 million people.”
Separately, a 2010 survey by the House Energy and Commerce Committee, based on documents from the four largest for-profit health insurers, found that before the ACA, companies refused to cover 1 in 7 applicants. would be 14%, although the report notes that “the actual number of coverage denials is likely to be significantly higher” than the number of documented denials. Yet if you take the entire US population under the age of 65 – around 271 million people – that means 38 million could face denial of coverage. It is also much less than 100 million.
The health insurance market is experiencing high churn, so many people may experience a coverage gap of only a few months. An estimate, by the Commonwealth Fund, said that in 2020, 9.5% of adults “were insured but had missing cover in the past year”.
“At any given time, most people with pre-existing conditions would not face insurance denial, even without the ACA,” Levitt said. “But for people who lose or quit their jobs, they could be vulnerable to rejection from the individual insurance market because of their pre-existing conditions without the ACA. The ACA guarantees access to coverage for people with pre-existing conditions during their lifetime, regardless of location or place of work.
The White House declined to comment.
Biden leans too much on his skis here. The figure he uses, 100 million, includes everyone with a pre-existing medical condition, but a large percentage would likely not face denial of health care coverage, let alone higher premiums. A better number to use would be at least half that size. He toned down that statement somewhat by using the word “may”.
Additionally, he claimed, “That’s what the law was like before Obamacare.” This statement ignores the central role that HIPAA has already played in reducing the fear of losing coverage for people in employer-provided plans — more than half of Americans under age 65.
Nonetheless, the ACA has certainly simplified the system, with its pre-existing conditions provisions among its most popular elements. When Republicans tried to repeal the law in 2017, they discovered how difficult — and politically perilous — it was to introduce new rules and uncertainty for people with pre-existing conditions.
The President wins Two Pinocchios.
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