The proclaimed vision for Obamacare versus reality has always been tough for people to accept, first because of the protective shield placed around anything "Obama," secondly, because its clever timing disguised many of its failures and then President Obama's lies until after Obama's re-election, and third because it handed so much power for rule-making, modifying and reinterpreting over to administrative agencies that they simply adjusted the law to accommodate their overriding purposes, make Obama and his health plan look good.
That became much harder over time as people realized some of the truths of Obamacare. But the worst flaw of Obamacare was the egotistical fanaticism that put blinders on then President Obama that resulted in his epic failure to show the discernment, judgment and vision which for decades before had prevented prior lawmakers from prematurely enacting a health care law just for the sake of saying they did it. This is important to realize as the country gloms onto the next big thing, Medicare for All.
And so, as the politically motivated timing of the real Obamacare occurred in 2014, past Obama's reelection, we experienced the individual mandate, we experienced the exchange prices going up, we witnessed the anemic numbers of enrollees in exchange plans and we experienced the surge in pricing and reductions in coverage for the rest of us. And it got worse when the payoffs provided to insurers to induce their participation expired in 2017 (the three Rs, two expired in 2017) and they left the exchanges all together.
All that was left of the lofty goals of the false promises of the untruthful President was an ongoing manipulation of numbers by the Obama Administration to somehow argue that the reduction of "uninsured" could justify declaring victory.
And so gone were the expectations of keeping your plan. Gone were the expectations of every family saving $2,500 a year. Gone were the hopes of preventing medical bill bankruptcies and being one illness away from financial devastation.
Instead, everything shifted to this numbers game, the "number of enrollees" game, forfeiting examination of how bad insurance got under the bare minimum standards imposed by Obamacare, ignoring the age discrimination provisions of the law, ignoring the ongoing difficulties of narrow networks and increasing exclusions, ignoring the omission of addressing a public option, controls on drug costs, and balance billing.
We got a decade-long manipulation of numbers game that required more and more imaginary and concocted explanations in order justify the law as time went on merely on the basis of these reductions in the number of uninsured. And now, we're seeing the same and worse with ideas for Medicare for All.
Government predictions for enrollment in Obamacare exchange plans were always anemic and lower than projected when sold to the American people. As a matter of fact, in 2015, in an attempt to bump up the percentage of people formerly uninsured who were now insured, having inflated enrollment numbers as much as possible, to improve the percentage the CBO adjusted the other number, the number of individuals uninsured to begin with.
The CBO confessed: “…slightly lower estimate of the number of people who will gain insurance coverage because of the ACA,” (CBO, Pub. 49973, page 19). Yeah, the number of uninsured was lower than previously stated. (See Partisan Creep? CBO and Obamacare," http://conoutofconsumer.blogspot.com/2015/03/partisan-creep-cbo-and-obamacare.html).
This was not only true for exchanges, but in 2016 became evident that it was true for the number of people who allegedly became insured under expanded Medicaid: "In 2016, after the release of a growth of Medicaid enrollees, Jonathan Gruber, originator of the 'stupidity of the American voter,' commented regarding expanded Medicaid, that the enrollment number included millions of people who were ALREADY eligible for Medicaid who came 'out of the woodwork' and enrolled." (See Are we still "stupid"? Obamacare and 2019, http://conoutofconsumer.blogspot.com/2018/10/are-we-still-stupid-obamacare-and-2019.html).
There was seemingly no limit to what the Obama Administration would do to keep its last claim alive, that the problem of the uninsured had been "solved" by Obamacare. However, whatever the originally claimed number of uninsured was, it was clear that there were and are still tens of millions of uninsured Americans. Some put the numbers at 27.3 million in 2016 and 28 million in 2017, so their work was and is cut out for them.
Yes, there was a big drop in the number of uninsured in 2014, when it became a tax-penalty offense not to purchase the consumer financial product of health insurance under the ACA the government payer-insurance payer partnership law. No surprise there. Yes, giving more people near free health insurance and near-free health care under expanded Medicaid also provided a drop in the number of uninsured.
But the fact of tens of millions who stubbornly remained uninsured, the Obama Administration had to turn its efforts and attention to making the numbers sound great and warning that without the law things would deteriorate into some dystopian mud-pit of misery.
In efforts to boost government numbers of who enrolled we also saw the government go to court to force people to accept premium assistance under Obamacare, government payouts, just to get them on the Obamacare rolls, King v. Burwell. You've got to be suspicious when an Administration goes to the Supreme Court to force people to accept government money.
We also found out that in breaking down the number of enrollees, those who had health insurance but were forced onto Obamacare were counted as "new" enrollees, not as people who already had health insurance in another place but found out like the rest of America at the end of 2013 that they could not keep their health plan.
We also found out that Obamacare included millions of fraudulent enrollees who either didn't exist or shouldn't have been eligible. (The Government Accountability Office). In response, in 2015, CMS explained to the GAO regarding its findings: "According to CMS, its document processing contractor is not required to authenticate documentation; the contractor told us it does not seek to detect fraud..." GAO-14-705T: Published: Jul 23, 2014, repeated in July 2015,"HealthCare.gov's document-processing contractor 'is not required to seek to detect fraud,' said Bagdoyan." That's right, authenticating documentation is unnecessary as is detecting fraud…That'll help boost numbers.
We also found out that many people enrolled in exchanges did not keep up with their premiums and that after the government's three-month continued payments without the insured paying, those people too left Obamacare, so end of year numbers were lower than the original numbers for each year.
So, today, when Medicare for All or Improved Obamacare is being pushed, we have a huge stake in objecting to titles in headlines like those in "Modern Healthcare," "Fewer People Maintain Obamacare Coverage Without Auto-Enrollment," 9/23/2019, by Shelby Livingston. In this article we get a resurrection of the Obama-years' scam about the "uninsured."
In that article, Livingston addresses auto-re-enrollment, though mistake one, it's referred to as auto-enrollment. The article warns that 30 percent of Obamacare enrollees would drop if CMS discontinued auto-enrollment, referring to JAMA research. I'm not seeing it.
The article conflates information from CMS and the separate research put out by JAMA to present a misleading conclusion that "Researchers found that losing the option to automatically enroll in coverage was associated with a 30 percentage point drop in enrollment."
First, go to JAMA. Though I won't pay for JAMA "research" because of prior pro-Obama bias presented in their "journal," you can't help but notice that the last "free" sentence we're provided with is that "While evidence suggests that administrative barriers to reenrollment are associated with reductions in Medicaid coverage, it is unknown whether elimination of automatic reenrollment is associated with decreases in reenrollment in the marketplaces." (Association Between Having and Automatic Reenrollment Option and Reenrollment in Health Insurance Marketplaces, Coleman Drake, PhD and David Man Anderson MS).
Perhaps that sentence isn't clear to Livingston, but it should be pretty clear to the rest of us, JAMA is referring to projected drops in enrollment by Medicaid beneficiaries if they're not automatically re-enrolled and states that the impact on marketplace Obamacare plans enrollment is UNKNOWN.
OK, so we go to CMS March 2019 released data "HEALTH INSURANCE EXCHANGES 2019 OPEN ENROLLMENT REPORT," from https://www.cms.gov/newsroom/fact-sheets/health-insurance-exchanges-2019-open-enrollment-report.
CMS states that "Approximately 11.4 million consumers selected or were automatically re-enrolled in an Exchange plan during the 2019 OEP [open enrollment period] in the 50 states, plus DC. This is a decrease from 11.8 million consumers during the 2018 OEP."
Working with an 11.4 million total enrollment number for 2019, and CMS' number is consistent with the year over year and continued anemic enrollment in Obamacare exchange plans, there was a slight drop in enrollment from 2018 to 2019.
Next, we're told that Automatic Re-enrollees were 3,387,191 for 2019, UP from 2,865,774 people automatically re-enrolled in 2018, which represents 30 percent of the total 11,444,141 enrollees in Obamacare exchanges. The number simply states that for 2019 30 percent of Obamacare exchange enrollees were auto-re-enrolled versus 24 percent the prior year 2018.
For Livingston, plugging in the fewer people who enrolled in Medicaid without auto-enrollment (according to JAMA) and misusing the number of people who automatically re-enrolled in Obamacare for 2019, 3,387,191 stated as 30 percent (according to CMS), enabled Livingston to construct a scare piece that the end of auto-enrollment will result in a spike of that mysterious and ever-changing number of the uninsured.
But what's more interesting to me is the fact that CMS charts show that the total enrollment in exchange plans for 2019 was down, and the fact that active re-enrollees in exchange plans was down, but the number of AUTOMATIC Re-enrollees was up by SIX PERCENTAGE POINTS from 2018, which could very plausibly indicate that fraud is alive and well in Obamacare.
The point is, we don't KNOW why these auto-enrollments are UP when every other enrollment, new enrollment, active re-enrollment, total enrollment is down. It's definitely a curiosity, especially since other decreases in enrollment ranged from not statistically significant, like active re-enrollment which though it dropped is still the same percentage, or total enrollment, which though it dropped is still the same percentage, but auto-re-enrollment is up SIX PERCENTAGE POINTS.
Sure, maybe the same plans were offered to people so they just went with auto-re-enrollment. Sure, maybe people didn't know they were still enrolled, so that automatically was done to them. Sure, maybe some formerly eligible people got jobs that offer insurance and are no longer eligible. Or, perhaps, the increased number of auto-enrollees evidences increased fraud and perpetuation of enrollment of non-existing or ineligible people as the Government Accountability Office has found plagues Obamacare year after year.
Which brings us to the basic argument here: Auto-re-enrollment in Obamacare plans is harmful to consumers on two levels, the loss of choice of being placed AUTOMATICALLY in an exchange health insurance plan and finding themselves locked into insurance plans that are either the same plan for more money or a governmentally determined similar plan because their plan has been discontinued, a plan that potentially does not meet their needs.
Further, auto-re-enrollment is harmful because of the ongoing opportunities for fraudulent payments under Obamacare, which are ultimately supported by taxpayers' tax dollars, paying for fraud, a fraud well documented many years over by the Government Accountability Office, including ineligible or non-existent people applying for and getting Obamacare.
This ineligible enrollee-non-existent enrollee fraud doesn't even begin to address the individuals failing to report changes over the year in their income status leaving the government responsible to claw back the government's overpayments and wrongful payments on behalf of individuals. The claw back provisions of Obamacare are a joke, ranging from total IRS forgiveness given by the government at times, to capped amounts the government is legally able to seek reimbursement for, limiting government seeking claw back recovery for the full amounts of overpayments only for those earning more than about $49,000 a year for an individual and $100,000 a year for a family.
Again, you've got to be at least wondering what motivation the government has for encouraging fraud through non-claw back and failure to verify enrollment eligibility, and it should be obvious that in part it's likely motivated by the old anemic enrollment numbers and trying to keep them up in order to continue to proclaim the success of Obamacare.
Consumers should be FOR the termination of auto-re-enrollment and it would certainly be a small step in the right direction for President Trump whose promises regarding Obamacare have largely not been kept.
