Ezra Klein: Despite what the conservative media says, Obamacare is working great in the "real world"

From the moment liberal blogger Ezra Klein launched Vox as an “explanatory journalism” project, it has exemplified the prevailing conceits of the modern American Left. Sometimes useful, frequently ideological, and more than occasionally embarrassing, the work of Vox’s self-stylized wonks is required reading among those news consumers whose unshakable faith in their own intellectual superiority is a boundless source of smug satisfaction.  Klein’s latest dispatch serves up a delicious premise to these eager members of the so-called “reality-based community:” President Obama’s health care law has been a big success in the real world (Vox has offered countless variations on this same argument), yet it remains unpopular in many quarters because too many Americans have been fed misinformation by unscrupulous conservative media sources.  These sources, it goes without saying, are run by vulgar partisans — Hot Air gets a shout-out in the piece — whose fealty to the facts is far less fervent than the selfless servants of truth who populate Vox’s editorial team.  Klein’s conclusion:

On the whole, though, costs are lower than expected, enrollment is higher than expected, the number of insurers participating in the exchanges is increasing, and more states are joining the Medicaid expansion. Millions of people have insurance who didn’t have it before. The law is working. But a lot of the people who are convinced Obamacare is a disaster will never know that, because the voices they trust will never tell them.

“The law is working,” and the American people might understand that better if they weren’t subjected to the right-wing media’s ruthless conspiracy to deny them the truth.  (Strangely, this powerful, narrative-dominating cabal was incapable of defeating a weak incumbent president two years ago).  As one of the alleged merchants of deceit, I’m more than willing to stipulate that (a) certain critics’ doomsday predictions haven’t panned out (see, for instance, Klein’s example of insurer participation in some exchanges), and (b) that the law has, in fact, helped some people.  A recent Kaiser Foundation poll found that 14 percent of Americans say the ‘Affordable’ Care Act has impacted their family for the better.  The trouble is that twice that number said they’ve been directly harmed by the law, which was marketed as a win-win for all consumers.  Numerous national surveys have consistently tracked the same two-to-one, hurt-to-helped ratio.  People’s actual experiences are not a product of propaganda-driven confusion.  Setting aside Klein’s faulty presupposition that the expansion of Medicaid is an unalloyed good, his first two points fail rudimentary scrutiny.  Beyond the cloistered world of the goalpost-shifting wonkosphere, costs are most assuredly not “lower than expected,” nor is enrollment “higher than expected.”  Allow me to try my hand at explanatory journalism:

(1) Democrats promised Americans that Obamacare would reduce “everybody’s” rates by $2,500 per family.  Instead, back in the real world, premiums have continued to climb ever higher.  Many consumers have experienced double-digit increases, with average 2015 individual market hikes projected in the high single digits — to say nothing of pared-back provider networks or heavy out-of-pocket costs.  Employers are also seeing a continued uptick in their healthcare tab, with those costs being passed down to employees in the form of higher contributions and scaled down coverage.  Healthcare industry expert Bob Laszewski notes that the full extent of Obamacare’s premium increases won’t be realized until 2017, when the law’s bailout-style, taxpayer-funded reimbursement provisions for insurers sunset.  At that point, insurers will have a much firmer grasp on the composition of their risk pools (which have thus far skewed older and sicker than anticipated); they will no longer be able to sustain losses to grab market share, then fall back on public dollars to make them whole.  As for the national spending “cost curve,” the president said his law would bend it down.  The latest CMS numbers project healthcare spending as a percentage of GDP will climb from 17.2 percent today to 19.3 percent by 2023.  It’s true that costs and spending have increased at a slower rate since Obamacare passed, but the government’s own bookkeepers have primarily attributed that phenomenon to the anemic economic ‘recovery,’ not the ACA.  Overall, assertions that premiums and costs are “lower than expected” will come as an insulting surprise to many average people — and not because they’ve been watching too much Fox News.

(2) Similarly, enrollment is not “higher than expected” by any reasonable benchmark.  The nonpartisan Congressional Budget Office projected that 12 million Americans would obtain health insurance through Obamacare in 2014, with the Obama administration boasting that between Medicaid expansion and the exchanges, they’ve hit the 14 million mark.  But two comprehensive federal surveys released in recent weeks have shown dramatically lower numbers, with the US Census Bureau indicating that the number of uninsured Americans has actually increased.  Data provided by the CDC, even after being augmented with generous assumptions, pegs the number of newly-insured Americans at less than six million — total.  Furthermore, HHS’ downward revision of its “eight million enrollments” football spike doesn’t account for the hundreds of thousands of consumers who are in the process of losing their coverage and/or premiums due to ineligibility, nor does it reflect the significant attrition of paying customers being reported by leading insurers.  The administration conjures its grand numbers via sleight of hand, “counting” new Medicaid enrollees whose sign-ups had nothing to do with Obamacare, as well as millions of people who have complied with the law’s individual mandate after being thrown off of their existing plans.  Various independent studies have concluded that a substantial majority of “new” exchange exchange enrollees were previously insured.  And as always, I’m amused by Obamacare supporters’ boisterous high-fiving over the fact that millions of people have engaged in behavior that is now legally mandated.

(3) We’re onto well-trod ground now, but no rebuttal to “the law is working” would be complete without mentioning that millions of people have been dislodged from their preferred health plans and caregiver arrangements as a direct result of Obamacare, with millions more to come.  This constitutes a gross violation of a pair of unequivocal vows repeated endlessly by the law’s boosters.  People cannot necessarily keep their plans and doctors — a reality that will again hit home for many consumers during the re-enrollment process (for reasons explained here), and when the president’s temporary, frantic, unilateral “fix” expires in those jurisdictions that went along with it in the first place.  The administration’s own internal estimates predicted that 93 million Americans would eventually lose their grandfathered coverage status under Obamacare, and one of the law’s primary architects is now boasting that he expects 80 percent of Americans who receive their insurance through work will lose that coverage within a decade.  Those people will be better off, Dr. Zeke Emanuel argues, and some conservatives might even agree in principle, to a certain extent.  But “most of you will lose your current coverage, and that’s a good thing,” wasn’t the sales pitch.  The sales pitch was, “If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.”  Comprehensively, utterly false.

(4) As we approach the next open enrollment period — which was conveniently delayed until after the midterm elections — the so-called “back end” of Obamacare’s online portal is still incomplete.  This function is supposed to seamlessly merge the government’s records with private insurers’ data, in real time.  Without a functional back end, costly eligibility discrepancies will continue to arise, and the true, up-to-the-minute number of enrollees will remain shrouded in mystery. This system was supposed to be up and running in the fall of 2013.  The Obama administration is now suggesting that it won’t be ready until sometime in 2015. Due to this delay and a number of additional factors, Laszewski anticipates another chaotic enrollment period, full of unpleasant surprises even for those who may believe they’re squared away.  Meanwhile, several states have completely abandoned their Obamacare exchanges, flushing hundreds of millions of dollars down the toilet in the process.  Vermont’s website was recently yanked offline “for weeks, not days” for maintenance, while the Minnesota marketplace’s re-enrollment capacity is reportedly in very serious trouble.  Oh, and the government admitted that Healthcare.gov was maliciously hacked over the summer, as data security experts warn that real vulnerabilities remain.  A Government Accountability Office (GAO) probe revealed that 11 of its 12 non-existent consumers managed to obtain Obamacare coverage and subsidies online and over the phone.

(5) Sundry additional assurances have been unceremoniously jettisoned as well.  We were told that Obamacare would reduce healthcare-related deficits.  After various accounting gimmicks are cleared away, the opposite appears to be the case.  CBO, for its part, has given up trying to track the law’s long-term fiscal impact, citing the administration’s endless on-the-fly changes.  We were told that current seniors’ Medicare coverage would be unaffected by Obamacare, which would only serve to lengthen the former program’s solvency lifespan.  Verdicts: Not true on the first count, and highly implausible on the second.  And we were told that Republicans and pro-life Democrats were lying in 2010 when they warned that the new law would result in taxpayer-funded elected abortions.  A recently-released GAO investigation revealed who was telling the truth (spoiler: Obamacare is funding elective abortions).

Obamacare has shattered virtually every major promise its supporters advanced during the public debate of 2009 and 2010.  Premiums are still rising (sharply, in many cases), out-of-pocket costs are increasing, access to care is receding, millions have been unable to retain their preferred plans and physicians (with many more cancellation letters to come), the national health spending trajectory is still pointed upward, the enrollment process is still plagued by technical problems, major components of Obamacare’s less-than-secure website still aren’t built, nonpartisan experts agree that the law is harming the economy, a supermajority of Americans directly impacted by the law thus far say they’ve been hurt by it, and its overall approval rating has languished underwater by double digits for years on end.  “Working.” 

In Voxland, Obamacare is a success.  In the real world, it’s a mess.  But a lot of people who count themselves among the pro-empiricism, pro-science, “reality-based community” will never know that, because the voices they trust will never tell them.