Another Unforced Error On Selling Obamacare

The Obama administration has done an excellent job policy-wise with the Affordable Care Act, but politically has made a few major mistakes along the way. The most recent was discovered today when Bloomberg reported that the administration had made mistakes in reporting the number of people who obtained health coverage through the exchanges in its first year. The error came from adding sales of dental plans available under the Affordable Care Act to the total number who actually purchased plans.

HHS Secretary  Secretary Sylvia Burwell responded on Twitter that, “The mistake we made is unacceptable. I will be communicating that clearly throughout the dept.”

From a practical point of view, the mistake does not really change anything. The important factor is the benefits provided, not the number of people who signed up the first year, especially when the number was depressed by a dishonest right wing smear campaign. The actual number still exceeded the predictions of the Congressional Budget Office. Nearly seven million did obtain coverage on the exchanges in the first year, with about seventy percent happy with their coverage–a number comparable to those receiving employer-paid coverage and Medicare.

Unfortunately an error such as this plays into the false right wing narrative that the Obama administration was not transparent in promoting the Affordable Care Act. They ignore the degree to which every aspect was publicly debated for months, and every version of the law was posted on line. Of course many conservatives were probably unaware of the discussion which was occurring as the right wing media was too busy spreading lies than to actually report on what was being openly discussed.

Man on the right are cherry picking and distorting the words of Jonathan Gruber, as I recently discussed here and here. They falsely claim that Gruber was the “architect” of the Affordable Care Act and falsely attribute his views to the Obama administration. Gruber was an outside academic consultant who had worked on Mitt Romney’s health care plan. He was paid to make economic projections based upon this to predict the economic effects of Obamacare. He had no role in the legislative strategy to pass Obamacare, and does not speak for the Obama administration in making statements which Obama disagrees with.

Being an academic outside of Washington, it is very likely that the somewhat convoluted legislative actions used by both parties to achieve the best scores from the Congressional Budget Office might seem to lack transparency. This does not mean that those promoting Obamacare were in any way dishonest. They honestly presented the facts about the law. In contrast, when George Bush pushed through his Medicare drug plan, he not only lied about the cost, but threatened to fire the chief Medicare actuary if he testified before Congress about the true cost.

Gruber’s claims of a lack of transparency would be more meaningful if he actually demonstrated any areas in which the proponents of the ACA were not open about the plans. He spoke about the mandate, but this penalty for not purchasing insurance was widely discussed before passage. He also concentrated on how the ACA is a transfer of wealth, but this was both openly discussed, and a common feature of all insurance. All insurance plans transfer wealth from those who pay premiums and do not wind up needing the coverage to those who receive benefits. While conservatives are quoting Gruber because his statements seem to reinforce their biases, once you look at the details there is no evidence of dishonesty present.

On the other hand. , the real dishonesty came from Republicans who lied about death panels, the number not paying their premiums, the effects of the ACA on jobs and the economy, the cost of coverage, and falsely claiming that Obamacare is a government take over of health care.  Even the corrected numbers show that far more people purchased coverage than many Republicans have claimed. Republican politicians continue to repeat the same lies even when disproven.

Prior Political Errors

Unfortunately the error in reporting the number who purchased coverage is not the first unnecessary error which wound up hurting politically. The most prominent error was in failing to properly test the computer programs behind the exchange before they went live in 2013. The problems were quickly fixed and the exchanges opened successfully this week, but the Obama administration never fully recovered from the poor first impression.

The second error was in over simplifying the issues when making statements that people can keep their own plans and/or their own doctors. Obama was being honest in the context in which he was speaking, but in over simplifying the matter in this way he was incorrect. Obama was responding to far more inaccurate right wing claim that the Affordable Care Act amounts to a government take over of health care. They spread horror stories of people being forced to lose their current health plans (and doctor) and instead being placed on some imaginary government-run Obamacare plan. I had patients call me in horror, asking if they would be lose me as a doctor because of having to change to Obamacare.

Obama was right in answering that people would not be forced into a new government plan and would not arbitrarily be forced to change doctors.

He was incorrect  in how he worded it because other factors were involved. Insurance companies elected to cancel plans, often when they could be grandfathered in. Doctors go in and out of health plans every year, regardless of Obamacare, but Obamacare does not assign people to new doctors. With or without Obamacare, some people would have to change health plans and doctors every year.

Most people had the option to get insurance, from the same company as before if they desired, with better coverage at a lower cost. It is also a bit ambiguous as to what keeping the same plan means considering that in the individual market it has been common for insurance companies to substitute similar but different plans quite frequently. Most people would feel like they had the same plan as it was from the same company with only minor differences (or with better coverage).

When Obama realized his statement was technically wrong, he not only apologized but acted to make it right by making it even easier to grandfather in old plans. Many of the old plans which were discontinued provided extremely limited coverage for the price, and people were better off replacing them with a better plan. I have often seen patients with plans purchased on the individual market in the past who were shocked to find that their plan paid nothing or only a tiny fraction of their bills. The Affordable Care Act guarantees both that health plans will provide reasonable coverage and that nobody can be dropped because of developing health problems, as frequently happened in the past.

By guaranteeing that people cannot be dropped from their health plan, by making insurance more affordable,  and by providing a greater choice of health plans, it is far less likely that people will have to change their health plan or doctor against their will as happened in the past. For the most part, Obama was right, but he worded this in a poor way as there were exceptions. Needless to say, Republicans concentrate on the rare cases where Obama was wrong, even though their health plans would ultimately lead to far more people being unable to keep their insurance or their doctor. By making these political mistakes, the Democrats have made it easier for Republicans to mislead.

Now yet another mistake has been uncovered which means little but which Republicans will be able to use to mislead the public.