Enrollment

Hot off the presses, the Centers for Medicare and Medicaid Services has the 2017 enrollment numbers. Now, can we trust what the Trump regime is telling us about these numbers? I'm with our buddy Charles Gaba, they look likely enough to be true. He's the enrollment number guy, and if they work for him, they're solid. Total enrollment for the year in private plans, not including Medicaid, is 12.2 million, down about half a million from 2016. Of that a little more than 3.8 million are new enrollees and nearly 8.4 million are re-enrollees. People not abandoning the marketplace, but indeed sticking around. So, enrollment is pretty darned stable.

Risk Pool

After the initial release of enrollments on the federal exchange for 2017 from the Obama administration, Larry Levitt, vice president of the Kaiser Family Foundation, noted that "26% of ACA marketplace enrollees are 18-34, the same as last year. You'd expect that number to go down in an insurance 'death spiral.'" CMS tells us, now that all the enrollments are in, that 36 percent of enrollees are aged 0-34. Why that matters? The 18-34 group is the lowest-risk demographic, statistically the healthiest and the cheapest to cover.

Another KFF analyst, Cynthia Cox, notes that while people buying insurance through the law have been sicker than insurers projected at the beginning—a result of so many going so long without insurance and regular health care—there isn't evidence that the pool of people enrollee is getting sicker. "Between the subsidies the people are getting, the continued strong enrollment, generally, and the fact we haven’t seen a significant drop off in the young adult age range," Cox told the Washington Post, "those are the signs we're not really seeing a death spiral yet."

Premium hikes

We've been through this drill before, in fact for the past three years of the ACA's implementation—"Premiums are skyrocketing!" Republicans shout. "No one can afford it!" That remains bullshit. In 2016, premiums in Obamacare plans were 10 percent lower than the full premiums in the average employer plan nationally, according to an Urbana Institute study.

"But 2017!" they shout. Yes, there was a big hike—25 percent average across plans nationally. But that, says S&P in a Global Ratings analysis, wasn't built-in to the system. "We view 2017 as a one-time pricing correction," the report found. It was an adjustment insurers were making to help them close losses from the previous few years when they had to take on more unhealthy customers than anticipated. In fact, free market competition might have encouraged them to offer too-low rates in the first few years.

(Incidentally, if there's anyone to blame for big premium hikes, give it to Sen. Marco Rubio (R-FL) for his shenanigans, in killing what he called and insurance company "bailout." In fact, it was a "risk corridor" for insurance companies built into the law that created a fund, paid into by companies who had profits, to help out companies who took a hit.)

What's never included in a follow-up question from a journalist when these folks scream "premium hikes" is the fact that more than three-quarters of Obamacare's customers don't feel the impact of those increases. In 2017, CMS reports, 84 percent of them are getting subsidy assistance. The subsidies on average cover about 73 percent of the gross premium cost for an average monthly premium cost to the consumer of $106 per month across all types of plan.

Taken all together, this makes Obamacare pretty damned stable on the private side of things, and so far not bankrupting the nation on the Medicaid side of things. That's because the law does the one thing Republicans really hate—tax the wealthy to help pay for it.

Medicare

So let's taken on another of Paul Ryan's favorite lies: "Medicare is going bankrupt" because of Obamacare. It's not. The law extended Medicare's solvency by 12 years, until 2028, relative to its outlook before the law. In fact, the Medicare provisions in the law will save the federal government more than $1 trillion on Medicare in the next five years over what the Congressional Budget Office projected when the law was enacted. That is, if the law remains intact.

Here's the sexy way of saying that: 37 million Medicare enrollees have gotten free preventive care since 2013, including flu shots and cancer and chronic disease screenings; and 8 million beneficiaries have saved more than $11.5 billion since 2010 on prescription drugs. That's $11.5 billion in seniors and disabled people's pockets.

Want to talk saved lives? Let's talk saved lives. How about 87,000 saved lives in just its first few years and just in hospital care alone and just for Medicare. That's thanks to procedures enforced by the law that make sure patients get the right prescriptions, don't undergo unnecessary procedures, and have reduced exposure to hospital-based infections. Readmission rates—patients having to return to the hospital—have plummeted. This doesn't even begin to talk about the tens of thousands—as many as 43,000 a year—whose life-threatening illnesses have been caught and treated because they finally could go to the doctor. Or all the immunizations that prevented flu deaths. Or all the risky pregnancies that have been either avoided or managed.

Is any of this to say that there aren't things Obamacare could be doing a lot better? Of course not! The deductibles and out-of-pocket expenses for too many people are way too high. There are plenty of geographical areas that don't have enough insurers (in both the Obamacare and the off-exchange markets). The failure of 19 Republican states to expand Medicaid has left massive disparities in coverage (which isn't the fault of the law). There's plenty of room for improvement in the law (which is what most voters say they want to see happen, by the way, most of the time in pretty much all of the polling rather than repeal).

But now that the law is threatened, those drawbacks are seeming a lot less problematic than all the good it's done, and its popularity is reaching new heights.

x Support for the Affordable Care Act (aka "Obamacare") has never been higher https://t.co/ZponXpIZGF pic.twitter.com/uEM6ugFC0Q — Conrad Hackett (@conradhackett) March 13, 2017

That's another thing journalists talking about the law should recognize, another Republican myth they need to be equipped to bust. Because we're talking about an actual life and death issue here, something that doesn't happen all too often in policy talks, outside of war. There are lives at stake here, and journalists need to keep that in mind. They need to keep the Republicans in power accountable to that.