Physicians Need to Know the Truth behind the ACA Enrollment Numbers

April 10, 2014
James Doulgeris

,
Nicholas Bonvicino, MD

The Obama administration’s health insurance enrollment numbers don’t match up to a conservative’s fact check. Who is telling the truth?

Congress and President Barack Obama have bet the health of every American on the Affordable Care Act’s (ACA's) success. Healthcare providers have their livelihoods added into the pot.

The first enrollment period of the new health insurance exchanges ended March 31. The White House is doing a victory lap, proclaiming success based upon “enrollment” without providing any details. A conservative think tank says the facts don’t even come close to checking out.

Both are telling the truth - but, not the whole truth, which, on the best of days, is intentionally misleading and, on the worst of days, is what we non-political types call lying.

In the event you have just returned from a long trip to oblivion and are trying to catch up, both Obamacare’s drafters and the nonpartisan Congressional Budget Office say that Obamacare will not be financially viable if at least 7 million Americans do not purchase insurance through the healthcare exchanges. Over a quarter of them need to be the young and healthy, as they represent its economic engine.

Veracity regarding those numbers is critically important to every American.

The White House proclaims Obamacare’s success, claiming to have met its goal by enrolling 7.1 million Americans.

A Koch Brothers supported conservative think tank, the National Center for Public Policy Research, led by David Hogberg, Ph.D., was engaged by Fox Business’ Neil Cavuto to conduct a deeper analysis. It came up with very different numbers:

• Only 2.4 million of those who enrolled were previously uninsured;
• Half, or 1.2 million, of those previously uninsured have not paid into the system;
• 6,286,357 people lost their insurance under the ACA resulting in a net increase in the net uninsured, raising the total to about 45 million, according to the report.

The newly insured or reinsured that are actually paying into the system through the healthcare exchanges are what counts for Obamacare’s success. If Hogberg’s numbers are correct, this number is 5.9 million. People who lost their insurance and regained it through the exchanges count.

The wild card, which still remains uncertain, is how many young people have enrolled and paid in.

The White House correctly says that Hogberg’s number does not account for the 4.5 million newly enrolled on Medicaid or the 3.1 million young people now covered under their parents’ insurance. As positive as they are, those numbers do nothing to help boost the exchange numbers, reduce the premium increases, or reduce the sky-high deductibles that now make a mockery of the entire concept of insurance.

The real problem for all of us is that old adage: Figures never lie, but liars figure. Both of the parties in this case have a well-documented history of the latter.

So, what does all of this have to do with physicians?

The discourse is political, but the problem is practical. If Obamacare goes deep into the red, the Affordable Care Act, already well on its way, will rapidly become the unaffordable care act.

That leaves only one arrow left in Obamacare’s quiver - reimbursements to providers, which inescapably will have to go down by the hundreds of billions annually.

Physicians are the only people in a position to make the ACA work, but not if they don’t know where to start.

One faction putting Petunia Pig in a party dress and the other in a sty is an unacceptable tact when we all deserve and need the truth - all of it - with so much on the line.

That is where the trailhead to making Obamacare work for America lies, and lies are something we can least afford regardless of the political stripe of their makers.