Monday, December 21, 2015

Annals of derp: Not with a bang but....

And Ross will be whimperer-in-chief.

Image via ComicVine.
Monsignor Ross Douthat, Apostolic Nuncio to 42nd Street, isn't too upset about the failure of Republican predictions of Götterdämmerung for the Affordable Care Act, because he doesn't hold with those who favor fire, if you know what I mean; he sees the death of Obamacare more as a long, hideously painful affair, solitary confinement and protracted starvation:
First, after the initial surge, Obamacare’s enrollment numbers have mostly disappointed. Not in a catastrophic way — the law has knocked down the U.S. uninsured rate to about 11-12 percent, compared to a pre-Great Recession level of 14-15 percent. But depending on how you cut the numbers, it looks like the Obamacare exchanges will fall at least four million enrollees short of the target for 2016.
Also depends when you slice them, Ross, in our corrupted material world where nothing is eternal. Like if you get all your information from last October (as in every last link in that paragraph), a couple of weeks before the open enrollment period began, when all the numbers were pure guesses, you might end up mistaken. For instance, you could be missing the real numbers that came out on Friday, in plenty of time to get them into a Sunday column, confirming 6 million enrollments in Qualified Health Plans to date and some math involving state exchanges and automatic plan renewals that brings the total to something between 11 and 12 million QHPs already, or more than in the entire open enrollment period for 2014-15, and on track to reach Charles Gaba's projected total of 14.7 million signups by the end of the period (January 31).

The great Charles Gaba is projecting 14.7 million qualified health plan signups by the end of open enrollment. Not everybody is that optimistic, but not everybody has his track record either.

That "about 11-12 percent, compared to a pre-Great Recession level of 14-15 percent" is false, because we don't know what this particular rate (uninsurance for people over 18 including those of Medicare age) was before the Great Recession; Gallup started measuring it it in 2008. The Monsignor may not be trying to deceive us, just innumerate, but if you look at some data over the longer term, you can see for instance that the percentage of uninsured working-age adults was around 20% in 1997, getting a good deal higher during the Bush years (not just the recession), and was down early this year to 13%
(the gradual rise in the green line is mostly Medicaid, the abrupt rise in the purple Marketplace plans), while in the rate I can't help feeling we should care most about, the population as a whole including children, the decline since the recession has been from 15.7% in 2009 (and an average above 14% for the preceding 20 years or so) to 9.2% early this year, which is colossal.

White House. By February 2014 the rate was the lowest it had ever been in history (but close to what it was at the best moment, in the Carter administration, before the budget hawks started taking Medicaid away from the non-pregnant adults).
As to the "target" number of enrollments for 2016 to which the Monsignor refers, 21 million, it's not a target (set by HHS) but an estimate (prepared by the CBO), based on things they expected to happen all over the market, where some 8 million people were expected to lose employer-sponsored and non-group policies and thus be forced onto the exchange, through job loss, the cancellation of plans that weren't compliant with ACA, and so forth. But these fears had been greatly exaggerated the year before, when it turned out that fewer than one million lost policies, and they probably have continued to be so (the CBO estimate was published in January 2015, two months before the 2014 evidence was published).

That's good news, that the number of Marketplace policies needed is smaller because the general employment outlook is so much better than expected and the normal if-you-like-it-you-can-keep-it employer insurance is handling the new law so much better too. The Exchange policies are supposed to fill in the gap where traditional employer policies don't apply, not take over, much as some of us socialists might wish they would.

Anyway that's just the worst paragraph. There's something else going on, from the Yuval Levin National Review column Douthat is riffing off of, but Douthat himself doesn't know what it is—too wonky! Quite a bit too wonky for me, too, matter of fact, but I'm trying to figure it out and will put it out, insh'Allah, in a later post.

Update 12/25: A couple of days later, Jonathan Chait showed up, and is worth reading.

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