Getting the facts straight in the ACA reform debate

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

Dem-candidatesMany of us spend time fact-checking what political candidates say during the debates.

But sometimes we need to fact-check the moderators (or perhaps the TV producers who help create questions outside a moderator’s area of expertise).

Witness the last month’s debate among candidates for the Democratic Party’s presidential nomination. Most of it was focused on foreign policy, but there were a few health care questions. At one point, moderator Martha Raddatz noted that health insurance premiums had risen 27 percent in five years. She then asked Hillary Clinton how she would fix the Affordable Care Act:

Secretary Clinton, the Department of Health and Human Services says more than 17 million Americans who are not insured now have health coverage because of Obamacare. But for Americans who already had health insurance the cost has gone up 27 percent in the last five years while deductibles are up 67 percent. Health care costs are rising faster than many Americans can manage.

What’s broken in Obamacare that needs to be fixed right now? And what would you do to fix it?

Where to begin unpacking that?

Raddatz cited a statistic pertaining to premium increases for employer-sponsored health insurance – but which was based on a five-year time period that included some years before ACA coverage expansion. She used those numbers to frame her question about the ACA – which also could have used some explaining, clarification and historical context.

The 27-percent figure comes from the Kaiser Family Foundation/Health Research & Education Trust 2015 Employer Health Benefits Survey. It did in fact find that health insurance premiums had risen from 27 percent from 2010 to 2015. That included only two years of ACA expansion – plus “Obamacare” plans actually are separate from employer-sponsored plans and not included in this data. Some provisions of the ACA do indirectly affect the coverage many of us get at work – preventive health for instance. But that wasn’t implemented in 2010 and it’s not even close to being the driver of costs. And it wasn’t what she was asking.

Secondly, according to that same Kaiser survey, employer-sponsored health plans had also risen 27 percent the previous five years – most of which was under President George W. Bush, a decidedly un-Obamacare era.

And we have apparently forgotten that health insurance inflation was even higher in the not-so-distance past. For 2000-2005, premiums for employer-sponsored plans rose a whopping 69 percent.

The 67-percent deductible increase she cited, also from that annual survey, pertained to workers’ coverage – and that cost shifting to employees also predated the ACA. According to the survey, the average deductible for all covered workers in 2015 reached $1,077 – up 67 percent from $646 in 2010. Back in 2006, it had been $303 – so as a percentage, the increase from 2006 to 2010 (the year of ACA passage) was even higher.

After the debate, I contacted Drew Altman, president and chief executive of the Kaiser Family Foundation, which conducted the study. He told me, “The premium increase has been historically moderate and not a function of Obamacare. The 67 percent increase in deductibles over the last five years is for employment-based insurance and also has nothing to do with Obamacare.”

We face many legitimate – even, pressing – questions about the affordability of health insurance – both the premiums and the out of pocket expenses including deductibles. But to have that debate, we need to start with clear and accurate premises. Reporters need to keep that in mind and attempt to correct the confusion, whether generated by candidates or moderators, as we cover the coming debates, in the primaries and the general election.

3 thoughts on “Getting the facts straight in the ACA reform debate

  1. Norman Bauman

    One of the election debate facts that we should check is Bernie Sanders’ claim that we spend 3 times as much per capita for health care as they do in the UK under socialized medicine.

    According to the OECD http://www.pgpf.org/chart-archive/0006_health-care-oecd in 2013 the UK spent $3,235, and the US spent $8,713, or 2.7 times as much, so within a rounding error Sanders is correct.

    A more appropriate comparison might be to Canada, $4,351, where we spend twice as much.

    As Hillary Clinton points out, taxes would be higher. The followup question for that is, “Would you rather pay $4,000 in taxes or $8,000 in private insurance premiums, for the equivalent health care?”

    A single payer system is not outside the mainstream in the medical journals, where for example Marcia Angell supported single payer when she was editor of the NEJM. Angell argued that incremental changes were doomed to fail, because they made the system more administratively complex, inefficient and expensive.

    Single payer is outside the mainstream in the major news media. I invite you to do a text search of the New York Times for “single payer” and related terms over the last 10 or 15 years, particularly during the period between Obama’s campaign and Obama’s decision to go with the ACA. I asked Elisabeth Rosenthal why the NYT ignored single payer, including in her own series on health care, and her answer, which I posted to the AHCJ list, was that she didn’t cover people who wanted to abolish Obamacare and she didn’t cover people who supported single payer, i.e., they were both outside of the mainstream.

    Angell is on the board of Physicians for a National Health Program http://www.pnhp.org/ . Journalists who want to follow up single payer can start with their PR guy, Mark Almberg (if he’s still there). I had a long discussion with him which I posted to the AHCJ list, and is in the archives. His best suggested article was probably Adam Gaffney’s, http://www.pnhp.org/news/2014/april/a-pro-single-payer-doctor%E2%80%99s-concerns-about-obamacare In my experience, PNHP survives fact-checking a lot better than free-market think tanks like, for example, the Manhattan Institute.

    I suggested a panel on single payer for the AHCJ national meeting, but they didn’t pick up on it. Who would have thought that a socialist like Sanders, who supports single payer, would have gotten so far in the Democratic presidential primary?

    Journalists can also ask our own Trudy Lieberman, after reading her article in Harper’s http://harpers.org/archive/2015/07/wrong-prescription/

    Jonathan Gruber, who is responsible for the Cadillac tax, said that “we don’t know how” to control health care costs. Actually, wrote Lieberman, Gruber really means, “we don’t know how under the constraints imposed by the system’s powerful stakeholders.” Like Billy Tauzin and PhARMA.

    I think journalists should ask fundamental questions, as Angell does, and not get lost in mind-numbing details and spreadsheets.

    So are Angell and Sanders right, that a Canadian-style system could work for us? Or is Clinton right, that free-market medicine and Obamacare, at twice the cost, is the best America can do? I think this is a question that journalists should be asking.

  2. Norman Bauman

    Here’s a good story that tries to answer Hillary Clinton’s questions by getting as specific as it can about Bernie Sanders’ plan.

    http://www.politifact.com/truth-o-meter/article/2016/jan/13/how-much-would-bernie-sanders-health-care-plan-cos/
    How much would Bernie Sanders’ health care plan cost the middle class?
    By Linda Qiu
    Politifact
    January 13, 2016

    Sanders’ proposal is one of the centerpieces of his campaign, so we wanted to examine it in detail. We found that it’s possible the middle class could see savings, but experts disagreed on whether Sanders’ plan pays for itself, based on what he’s laid out so far. The plan seems to rely on the most optimistic scenario for cost savings and efficiency.
    Sanders proposes to expand Medicare, the health safety net that covers those over 65, to all Americans. He hasn’t released a full plan yet, but he points to previous legislation he’s introduced, namely a 2013 bill for a single-payer Medicare-for-all system, as his general gameplan.
    To pay for it, Sanders would impose broad-based taxes: a 6.7 percent payroll tax on employers and a 2.2 percent tax on individual incomes under $200,000 or joint incomes under $250,000…. (Progressively higher rates for higher-income earners are described in his 2013 bill.)

  3. Norman Bauman

    Now that Sanders has released his plan, here’s a good story from Vox about a study by Kenneth Thorpe which challenged the accuracy of the predictions in Sanders’ plan. Paul Krugman, who has also criticized Sanders, cited this article and Thorpe’s study. This is fairly technical, although they do get into a few ad hominems.

    http://www.vox.com/2016/1/28/10858644/bernie-sanders-kenneth-thorpe-single-payer
    Study: Bernie Sanders’s single-payer plan is almost twice as expensive as he says
    Dylan Matthews
    Vox
    January 28, 2016

    Bernie Sanders’s health care plan is underfunded by almost $1.1 trillion a year, a new analysis by Emory University health care expert Kenneth Thorpe finds.

    Thorpe isn’t some right-wing critic skeptical of all single-payer proposals. Indeed, in 2006 he laid out a single-payer proposal for Vermont after being hired by the legislature, and was retained by progressive Vermont lawmakers again in 2014 as the state seriously considered single-payer, authoring a memo laying out alternative ways to expand coverage. A 2005 report he wrote estimated that a single-payer system would save $1.1 trillion in health spending from 2006 to 2015.
    But he nonetheless concludes that single-payer at a national level would be significantly more expensive than the Sanders campaign believes, and would require workers to pay an additional 20 percent of their compensation in taxes. He also argues it would leave 71 percent of households with private insurance worse off once you take both tax increases and reduced health care expenditures into account….

    It comes down to five factors:

    Sanders assumes $438 billion more per year in administrative savings than Thorpe….

    Sanders assumes $324 billion more per year in prescription drug savings than Thorpe does….

    Sanders assumes $216 billion more per year in savings because Thorpe thinks eliminating copayments and deductibles will lead to people using a lot more health care….

    Sanders assumes $160 billion per year in savings relative to Thorpe because, they argue, he includes elective procedures like plastic surgery, which single-payer wouldn’t cover….

    Sanders assumes that states will pay $100 billion more per year in Medicaid and SCHIP spending than Thorpe does….

    (continued at Vox)

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