Flawed estimates only highlight ACA’s failures

I N the real world, people who don’t have insurance coverage cannot lose it. Yet in politics, pretending otherwise is treated as a valid argument against overhauling the Affordable Care Act, better known as Obamacare.

Last week, the Congressional Budget Office released its estimates regarding the cost and coverage impact of legislation passed by the House of Representatives that would repeal or revise many ACA provisions.

One of the big takeaways for Obamacare defenders is that the CBO estimates 14 million fewer people will have coverage in 2018 if the House bill is enacted than would be the case if the ACA is left intact, and 23 million fewer by 2026. That estimate is similar to one released by the CBO earlier this year regarding an earlier version of the House reform measure, which predicted 24 million fewer people would have insurance if that bill became law.

Yet that earlier estimate highlighted serious flaws in the CBO’s analysis and provides reason for skepticism about its claims. For one thing, the CBO assumes Obamacare will begin working better next year than it has at any point since its passage in 2010.

In 2016, there were roughly 10 million people obtaining insurance through an Obamacare exchange. The CBO estimated that number would suddenly surge to 18 million by 2018 if the law was left intact, but that far fewer people would be covered if the House reforms became law.

Put simply, the CBO estimated that millions of people who don’t have insurance through an exchange today would “lose” coverage they would otherwise obtain next year. That’s doubtful.

As health policy expert Avik Roy has noted at the website Forbes.com, the CBO’s projections have long overstated the benefits of the ACA. At one point, the office estimated 22 million people would receive insurance through an Obamacare exchange by 2016. As already noted, the actual figure was less than half that.

One major reason for the CBO being so far off the mark is that federal forecasters believed Obamacare’s individual mandate would cause people to buy insurance, regardless of cost. That hasn’t proven true. Millions have chosen to pay a penalty rather than buy Obamacare coverage because it’s cheaper to go uninsured and the Obamacare policies provide relatively little benefit.

That was reinforced by a recent report from the federal Department of Health and Human Services, which found the cost of the average policy on the federal Obamacare exchanges used in 39 states increased 105 percent between 2013 and 2017.

The situation is worse in Oklahoma, one of three states where the report found Obamacare premiums have tripled in cost.

The CBO’s estimates suggest millions more would gladly forgo Obamacare coverage without the mandate, saying much reduced coverage would occur “because the penalty for not having insurance would be eliminated.” The CBO has even estimated many people will choose not to accept Medicaid coverage, even though it is virtually “free” to most recipients.

In a nutshell, the CBO predicts reform would cause millions to lose coverage they don’t now have, and that millions more would eagerly reject the coverage they do have because it’s such a bad deal.

Those aren’t conclusions that bolster the case for Obamacare, nor do they undermine the need for reform.