Monday, November 18, 2013

The Feeding Frenzy

I watched highlights from the Sunday shows yesterday afternoon. I was struck by the near unanimity of the opinions: Obamacare was in free fall. So was the President. He has clearly lost the trust of the people. And he has demonstrated extraordinary incompetence. In short, a feeding frenzy. Even MSNBC's Chris Matthews piled on.

Then I spent some time on Conservative websites - Red State, NRO, Weekly Standard and Commentary. The tone was dismissive, contemptuous, arrogant, triumphal, and (here and there) a word of pity for this poor benighted President who is so completely over his head.

No one charted a path for the ACA's demise. Obama was known to be finished. With his collapse would come the end of Obamacare. All of this was stated clearly, calmly, confidently. Nothing to question here. Move on.

Staggering. It really was.

Here are five questions I would like to have asked:
  1. Will Obamacare be repealed or substantially altered in the next six months?
  2. How many Exchange sign ups will there be by March 31 (private insurance, Medicaid)?
  3. How many of the estimated 10-12 million people in the old non group market will buy ACA compliant policies for 2014 (on or off Exchanges)?
  4. What will the average Exchange-based premium increase for 2015 be (announced next summer)?
  5. Will the number of people who are covered by employer-based insurance go up, go down, or stay the same, comparing 2014 to 2013?
Try to give an answer to these questions before you go below the fold. My answers are just below.

My answers/predictions:
  1. No. Democrats will largely stick with the President. The GOP will not get a veto-proof super majority.
  2. 6 million private; 4 million Medicaid. Original goals were 7 million/9 million, but states opting out account for 5 million lost Medicaid patients.
  3. 5 million - 2 million on Exchanges and 3 million direct with insurance companies.
  4. 5%
  5. Modest increase.
Will this be considered a success? Yes. Not by everyone, but by people that matter for winning elections - MSM and independents. The GOP will focus on the 5 million that were forced to buy ACA compliant policies, and the 2-3 million others that opted out of the insurance market and decided to pay the penalty. But research will show wide satisfaction in this group - most got what they felt was a good deal, even if they paid more.

The GOP is simply wrong here. Obamacare is here to stay. Its economic foundations will prove solid (the modest premium increases for 2015), partly because the new marketplace for ACA-compliant individual policies (on or off Exchange) constitute a single risk pool - and the old non group market members are generally very healthy, contributing to a balanced, sustainable risk pool.

Everything the GOP has said and is saying about the ACA is wrong. Not the policy preferences. The predictions about what would happen to premiums, to employer-based coverage, to sign ups, to the underlying economic model of the new risk pools, to the trend in healthcare costs. Every single prediction will be proved wrong.

If you ever wanted a textbook example of a group of people only able to see what their lenses allow in to their consciousness - here it is. We see only what our lenses allow us to see, which generally means, we always find what we think should be there. 

Ideology limits what we can see. Always has. Always will.

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