Thursday, July 12, 2012

Examining Walker's Claims Regarding the ACA in Wisconsin

Scott Walker made some claims about how the ACA will impact Wisconsin that I found rather surprising. So I did the sensible thing, I read the report he supposedly got the data from.

First of all:

100,000 people will be dropped by their employer-sponsored health insurance;
According to the cited report, "there will be 10,000 fewer Wisconsin residents covered via ESI due to the effects of the ACA. This represents less than a 1% decline in ESI enrollment."  (p 14) Walker seems to be referring to he figure on p. 14 which shows firms dropping coverage, individuals voluntarily leaving, and new firms gaining coverage. To assess the ACA obviously the net effects are the relevant figure, isolating one number is cherry picking. It should also be noted that it is likely that many of those voluntarily leaving their employer sponsored coverage for the exchange feel their options have been improved by the reform. No one has seriously claimed that there won't be winners and losers from this policy change (or any other), isolating the downside when the net effects are clearer and more intuitive is a poor way to present data.

59 percent of people who buy their own health insurance will experience an average premium increase of 31 percent
This is true enough, but it is important to note why it is happening. Costs increase due to enhancement of minimum coverage level, bringing the high risk pool into the larger market, and bringing new individuals into the health insurance market that could not previously get coverage. This is important, as I've noted before 5% of patients account for about 50% of healthcare costs. To prevent the kind of hot potato game that passes the costs of these patients from actor to actor within the system, driving up costs among other problems, it is essential that people have coverage that actually covers their costs. As it is today, there is a temptation for many people to seek coverage for their day to day health care issues, like taking a child in to get penicillin or for minor complaints, that won't provide coverage for something like a severe health care condition or accident. If we want cost reform to be a real possibility, it is essential that this aspect gets fixed. It should also be noted that this coverage expansion benefits everyone, none of us knows with certainty we won't experience an event that makes us a high risk tomorrow. Also, coverage will include prescription benefits, maternity care (rather important from a standpoint of societal efficiency), and mental health benefits (also important since this is a big risk for young adults).

150,000 people will stop buying health insurance in the private sector and will instead become dependent on the government and taxpayers
I believe this statement of the report is relevant, "We estimate that the traditional Individual Market sees an 83% decline, losing 150,000 members, while the newly reformed market will grow to 320,000 new enrollees."  (p. 12) I think it is a bit of a stretch to call the insurance exchange dependence on government. Sure, it's regulated but so is the current market. Some individuals will receive subsidies, but so do employers under current laws. I wonder if Scott Walker would like to call Apple a dependent on government for the tax subsidies it receives to purchase health care for its employees (if he would, that would make for a more interesting conversation than the one we've been having).

Between 2014 and 2019, Obamacare could cost Wisconsin taxpayers $1.12 billion; after all federal aid and tax credits are applied, the state’s portion of the bill will be $433 million
Fair enough, but while we're bashing Obamacare's individual level tax subsidies, why not bash the subsidies we give to employers. Also, net costs are likely important, how much of these costs are currently being incurred at the level of emergency room treatment for uninsured individuals or in social costs for children who don't receive necessary maternal care or adults who lack proper mental health care.

Approximately 122,000 parents, caretakers and pregnant women with an income of more than 133 percent of the federal poverty level will no longer be eligible for Medicaid.
Didn't see the details on this in the report. I do wonder how many of these eligible individuals are currently taking advantage of Medicaid and how many get their insurance through other sources. Medicaid is hardly the best available insurance for someone with other options. It's something to consider but I'd be surprised if it wasn't possible to get a state specific exemption to expand coverage.

On the whole, I find Walker's opinion piece entirely unconvincing. There are trade offs inherent in the ACA, but frankly they aren't very large. More could be said about better ways to institute health reform but block grants to states are a bit of a hand wave rather than a serious proposal. I know there's been an obsession with them since welfare reform, but every serious analysis of that reform finds that other elements had far more effect. It's not surprising that a Governor would like more money to disperse, and it has a rationale that many find intellectually appealing, but there really isn't much support for the idea that it is a superior method of solving problems.

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