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Spinning the Obamacare signups: How health care journalists brought us the story behind the numbers

Michael Joyce writes for HealthNewsReview.org and tweets as @mlmjoyce

Obamacare, Affordable Care Act, enrollment, signupsThe Trump administration is using the latest enrollment numbers for health care plans offered through the Affordable Care Act (ACA), published last week, as proof that those plans (commonly referred to as “Obamacare”) are a failure. But many journalists have since questioned not just the reliability of the numbers, but also how the administration is tailoring those numbers to suit their own agenda; specifically, declaring war on Obamacare.

Among healthcare journalists the story has generated significant discussion. A sentiment expressed privately by some reporters is that the numbers were presented by the Trump administration out of context and that the excluded context was actually the real story. Here are those numbers:

  • The pace of Obamacare sign ups in the last weeks of eligibility (for upcoming 2017 coverage) dropped last month. In the last two weeks of open enrollment — which ended on January 31, 2017 — there were only about 375,000 last minute enrollees, compared to nearly 790,000 who enrolled over the same period last year.
  • Final numbers published last week by the Center for Medicare and Medicaid Services (CMS) also showed that HealthCare.gov (the federal site that signs people up for Obamacare in 39 states) ended the year with 9.2 million sign ups, compared to a total of 9.6 million last year.
  • These numbers do not include totals from 12 states who run their own sign up programs (including New York and California), some of which (like Minnesota) have extended their deadlines. That final tally is due in March. Last fall the Obama administration predicted that when the state and federal numbers were totaled, over 13 million people would sign up for open enrollment. If that actually happens it would surpass last year’s enrollment.

Health care journalists tell the story behind the numbers

I am not an apologist for Obamacare. Some deficiencies are becoming evident, not the least of which are increasing premiums and decreasing participation by insurers. If you wanted to build an argument that Obamacare needs repair, or is “a failure”, this would be a good place to build your argument with actual evidence. But to take enrollment numbers that are incomplete, and may have been impacted by political maneuvering, is a weak argument that, I’m glad to say, many reporters jumped on.

Some excellent news stories — like this one from CNBC and another from CNNMoney — point out that there is a story behind the numbers. Not only that, many reporters made it clear why the neglected story has both relevance and far-reaching impact. First, is the potential to influence how the American people view the Affordable Care Act. Is it an abject failure that needs to be replaced? And, if so why? Or, does it have a decent chance at success but simply needs more time and modification? Secondly, major insurance companies are closely following the fate of Obamacare to gauge whether they want to stay with the program and, if so, what premiums they can afford to offer. Perceptions regarding the relative success or failure of Obamacare could potentially be a deciding factor in the health coverage of millions of people.

But what about the missing context that IS the real story?

“Obamacare has failed the American people, with one broken promise after another,” said HHS spokesman, Matt Lloyd, in a statement released just after the release of the CMS numbers last week. If this seems like a political statement from a political appointee bear in mind that his department oversees Obamacare and operates HealthCare.gov. In the first weeks of the Trump administration, Politico reported the HHS reportedly cut millions of dollars in advertising that was earmarked to boost last minute sign ups for ACA coverage.  That’s significant because most of these last-minute sign-ups are young and healthy people that tend to off-set the risk pool of those covered by the ACA.

“The Trump Administration’s efforts to suppress enrollment clearly had an impact, said Ben Wakana, who served as press secretary for the Department of Health and Human Services under the Obama administration. “When President Obama left office, enrollment was outpacing last year. Since taking office, the new administration deliberately sabotaged the law: pulled down advertising, threatened outreach efforts, and sewed uncertainty about consumer protections. … Republicans must come up with a plan before ripping their health care away.” [source: USNews]

Many Republicans in Congress have repeatedly promised they aim to gut Obamacare. But that rhetoric has already toned down and some Republicans are starting to speak of “repair” rather than “replace”. Specifics for an alternate plan are lacking.

Beyond the political posturing: One journalist’s take on the numbers

Kimberly Leonard, who wrote an excellent article on this topic last week for U.S. News & World Report, and who has been following Obamacare enrollment for some time, says there is much more to this story than just political posturing:

“It’s not just a political battle occurring on Capitol Hill. There’s a balance here. Yes, there is some good evidence to show that enrollment was on track until the ads were pulled. But I’ve also been talking with plenty of people these past few weeks who told me quite openly they can’t keep up with their premiums, they have fewer workable options, and even though they enrolled before they won’t enroll again. But I also think the real story here is not just the number of sign ups but the quality of those sign ups. Are they people with chronic conditions who really need insurance and maybe subsidies? Or are they people making a decent amount of money who can pay into the system? We don’t know if it’s more of the former, and if that’s the case, then that’s a less appealing environment for insurers. Insurers need to find the exchanges appealing in order to participate and to ensure the success of the Affordable Care Act. When many of them pulled out for 2017—citing losses—we saw premiums rise and competition dwindle, resulting in some unhappy customers; especially the estimated 6 to 9 million who don’t qualify for subsidies. These outcomes can provide ammunition to those who say Obamacare is failing, even though the reasons for these outcomes are multi-faceted.”

This suggests that the next few months will likely become a pivotal period in this country’s debate on healthcare reform. And more than ever, we will need smart, thorough reporting to translate the political rhetoric, “alternative facts,” and other partisan posturing that may be coming from both sides of the aisle.  

We used to debate whether we needed healthcare reform. Now we’ve progressed to how should it work? Regardless of who you voted for for President (and remember, Obamacare as we know it actually has a bipartisan origin that goes back at least 25 years) it is in all our best interests to carefully scrutinize the healthcare reform rhetoric this spring. Yes, there will be more numbers, but those numbers are people, possibly you or someone you know.

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Comments (1)

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Bradley E Flansbaum

February 8, 2017 at 9:14 am

Michael
Megan McArdle wrote a nice op on this very subject today. The point to highlight is her emphasis on the enrollment numbers and the low likelihood that advertising was the prime cause for the “fail.”

There was significant variation across states and to make ad buys the culprit invokes confirmation bias more than political meddling as root cause.
https://www.bloomberg.com/view/articles/2017-02-08/obamacare-exchanges-were-in-big-trouble-before-trump

Brad