The Known Unknowns

by Dave Schuler on April 1, 2014

After echoing my remark of yesterday (“the end of the beginning”), Megan McArdle considers some of the things we still don’t know about the PPACA:

· How many people have bought and paid for policies

· How many people have signed up for Medicaid who weren’t eligible before 2010

· How many people who are buying insurance didn’t have insurance before

· How the new policies compare to the old policies

· How much subsidies are costing

Will we know the answers in due course? Insurance expert Bob Laszewski isn’t so sure:

We only need ask the carriers for two numbers:
The number of people they insured (and were paid for) in both the individual and small group markets as of December 31, 2013––the day before Obamacare started covering people.
The number of people that were insured (and paid for) in both the individual and small group markets on a specific date––March 31, 2014, for example.
I will suggest that asking for both the small group and individual market numbers is important as people have a tendency to move between the markets, particularly as employers drop coverage and their people go, or don’t go, into the exchanges.

Then subtract one total from the other. We would have an excellent idea of just how many more people, net of any gains and losses, secured private insurance since Obamacare’s launch.

It would probably be best if the administration answered some of the open questions as quickly as possible and certainly within the next several weeks. I can assure you from personal experience that, as Mr. Laszewski asserts, the carriers know the answers and can provide them very rapidly. Congressional Republicans have telephones,too.

Update

See also Charles Ornstein’s consideration of some of the same questions.

Some of the law’s supporters don’t care how effective the PPACA is or isn’t. It’s the idea of it they support and they’re convinced that they’ve secured their victory regardless of the law’s performance or actual results. We’ll know in due course.

{ 7 comments… read them below or add one }

Jimbino April 1, 2014 at 1:14 pm

Silly.

Obamacare screws the young, single, childfree, healthy male to support the old, breeding, hypochondriac female. Any idiot can figure that the ones likely to eschew Obamacare are the former and those who race to sign up are the latter. So Obamacare can well be neutral with regard to number of insured while still being actuarially non-sustainable.

The hope is that the effect is great enough to launch the Death Spiral that will doom Obamacare

michael reynolds April 1, 2014 at 1:37 pm

Some of the law’s supporters don’t care how effective the PPACA is or isn’t. It’s the idea of it they support and they’re convinced that they’ve secured their victory regardless of the law’s performance or actual results. We’ll know in due course.

Similar to my position, which is that Obamacare has forced us to deal as a nation with a serious and persistent problem. Prior to this we were ignoring the issue, and now we’re not. It was “someone else’s problem” and now it’s ours, collectively. You cannot fix when you’re in denial and refusing to engage. So whatever the shortcomings, we are at least finally coping, and will continue to cope, as a nation.

steve April 1, 2014 at 3:22 pm

Most of the law’s opponents don’t care how effective the PPACA is or isn’t. It’s the idea of it they oppose. They already made up their minds before the first sign up period was even through. Most of us who follow health policy, and want something that works, are willing to wait to see the results, knowing it will take several years to see what really happens. The milestones will be interesting.

I think the big test comes in 2016. Basic poll sci suggests the GOP should take back the POTUS office. If the GOP controls House and Senate, what do they do with Obamacare? Do they try to amend it to make it work better, or at least not sabotage it, or do they dismantle and repeal what they can? They have never been that interested in health care reform, so I find it hard to predict.

Steve

jan April 1, 2014 at 3:58 pm

According to a recent RAND study, just 23% of new enrollees had no insurance before signing up. And, of those, just 53% have paid their first month’s premium, leaving the total of paid policies to stand at 858,298. That, IMO, is not a figure to crow about, especially in light of the much larger one, 6,286,000, who lost coverage because of Obamacare.

Another interesting statistic is that HC costs have been shown to have hit a 10-year high, growing at a much faster pace than before. Then we can be anticipating the next shoe to drop effecting the 15.9 million seniors who have medicare advantage policies — a hike effecting that benefit plan. This is supposed to come out in Sept. ’14, unless the dems attempt to delay or hide this as well.

steve April 1, 2014 at 5:53 pm

Wow. So wrong. It is well known that health care costs have been decelerating. Dave has posted on this and the potential reasons. Health care costs hit a new high every year, just like our population. The issue is the rate of rise.

Medicare Advantage costs more than standard FFS Medicare. Why do you want to subsidize the higher costs?

Steve

Dave Schuler April 1, 2014 at 6:07 pm

Here’s what jan appears to be referring to:

Health care spending rose at the fastest pace in 10 years last quarter, a development that could foreshadow higher costs for consumers this year.

Expenses for health care rose at a 5.6% annual rate in the fourth quarter, the Bureau of Economic Analysis said last week. The jump triggered a sharp upward revision in the government’s estimate of consumer spending overall and accounted for nearly a quarter of the economy’s 2.6% annualized growth in the last three months of 2013.

Driving the increase was an $8 billion rise in hospital revenue — more than the previous four quarters combined, according to the Census Bureau and Royal Bank of Scotland. RBS economist Omair Sharif says the increase in hospitals’ income was puzzling because the number of inpatient days dipped 1% during the fourth quarter.

It seems to me that if you attribute the slower growth in costs of the last year or so to the PPACA, you should probably attribute the faster growth to it, too. Just for the record I agree with the federal government’s actuaries: the PPACA has practically nothing to do with the slowing growth and it has practically nothing to do with it speeding up again.

Whether the PPACA will drive costs up is a question for the future. If the latest “doc fix” passes, I think we should expect that to drive costs up, too.

Andy April 1, 2014 at 8:21 pm

Steve,

Sure, medicare advantage costs more than FFS medicare, but it also covers more that FFS medicare.

“Most of the law’s opponents don’t care how effective the PPACA is or isn’t. It’s the idea of it they oppose.”

That and what Dave said about the laws proponents I think is basically accurate. One’s views about the PPACA depends largely on one’s politics and not any rational or objective analysis of the actual effects of the law which are, at this point, ambiguous at best.

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