Data Paranoia Watch: ACA Edition

Senator Barraso (Republican-Wyoming) follows in the fine tradition of Allen West in charging a conspiracy so vast…

From FoxNews, Barraso describes the Administration’s statement on enrollments [1] thusly:

“I don’t think it means anything,” he told Fox News Sunday. “They are cooking the books on this.”

The Administration’s estimates are depicted in this figure

ACA_enroll

Figure from Andrews, Park and Tse, “Ten Key Questions on Health Care Enrollment,” NY Times (27 March 2014).

The tabulation by Charles Gaba at ACASignup.net estimates 6.9 million enrollees by March 31 (h/t Paul Krugman).

See also Paul Krugman‘s discussion of the strange failure of the media to highlight the achievement of the “target”. Nonetheless, while we are likely well on the way to exceeding the 6 million target, there are several targets that we do not yet know whether we have hit [3] (although I am not sure that it is required that actual 40% youth enrollment is necessary for viability).

Several observers have raised the issue of paid vs. unpaid enrollments; Secretary Sebelius has indicated 80-85% of enrollments are paid. ACASignups provides an estimate at 85%, as well.

For a broader measurement of coverage under all aspects of the ACA, see this graph:

aca_chart_140330b (1)

Figure 2:from ACASignups.

For other examples of data paranoia, see here and here.

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42 thoughts on “Data Paranoia Watch: ACA Edition

  1. jonathan

    I’d say it’s more wishful thinking. And people are entitled to their wishes.

    In this case, those wishes extend to mid-term elections and the GOP is putting a bunch of eggs, close to all of them, in the anti-Obamacare basket. 7 million is a problem because the sheer size of the number forces consideration of what the GOP would do instead.

  2. Hans

    The real question, Professor Chinn, is how many uninsured acquired health insurance;
    not how many where insured before hand, not to mention the amount of new Medicaid
    sign ups…Funny, how all that pertinent data is missing in action. (AWOL)

    This is the first of hundred of thousands, all part of a scheme to advance the Socshevik
    movement. Sorry, no conspiracy nor Alan West or the Kock triplets…

    http://www.10news.com/news/local-couple-upset-after-receiving-pre-marked-voter-registration-card-from-covered-california-03282014

    Lt Col. Alan West is a great American, whom I would be proud to serve under! He has articulated some of the following.
    http://cnsnews.com/commentary/j-matt-barber/we-have-become-communist-states-america

    For those right wingers, especially in the state formerly known as California, you will be familiar with the
    work of Zombie, in the dysfunctional state of San Francisco, where not having a business licence can lead
    to an arrest, but if you are an illegal the police will redirect you to the nearest welfare office..

    http://pjmedia.com/zombie/2014/03/10/progressive-racism-the-hidden-motive-driving-modern-politics/

    We now require the intervention of the National Government to provide health insurance: the American
    public have become nothing more than cattle and we all know whom the herders are…Keep sitting in
    your stadium chairs and your TV knobs tuned to Dancing With The Stars, with your local council chairs
    sitting empty – as the professorial Mandarin discharges your civil duties…Hell is just around the corner.

    America is dying right before your eyes, as we celebrate diversity, multi-multiculturalism and trans gender
    reassignment…

    As Einstein once echoed, there are two things infinite, the universe and ignorance.

    1. Menzie Chinn Post author

      Hans: I believe the typical abbreviation for “missing in action” is “MIA”. “AWOL” is the typical (i.e., for people in the real world) abbreviation for “absent without leave”.

      In any case, I enjoyed your reference to “TV knobs” — very nostalgic. One criticism — you should have included in your comment “Soylent Green is people!”

    2. 2slugbaits

      Hans And while we’re in the business of correcting abbreviations, I work with a lot of crazy field grade officers and very few would appreciate the abbreviation “Lt Col” in front of their names. When used as a title the correct abbreviation is “LTC” and when talking about the rank in general it’s “O5″ (pronounced oh-five). So there’s a lesson in Army etiquette.

      1. Hans

        Sorry Baits for presenting my antiques; this old war horse served during Vietnam.

        Thank you for the upgrade in grade.

  3. MarkS

    Thanks Menzie for providing the current data on ACA performance. I am grateful that several million people now have access to “affordable” medical insurance that otherwise would have been left out in the cold or left for days in the waiting room waiting for charity. There is little doubt however that the elephant in the room remains the unconsciously high price levels and markups for drugs and medical services. The US is now paying close to 18% of GDP on healthcare with the CBO projecting costs as high as 22% by 2038 ! For the most part healthcare in America is a Balkanized racket, with no price discovery before services for the consumer, regulatory monopolies for providers, and vast governmental subsidies to ensure profitability.
    I would like to interject a couple of anecdotes to illustrate the problem on a small scale-

    1). I will be going in for a colonoscopy next month and found that I would have to pay $175.00 at CVS for 32, 1.5 gm prescribed “OsmoPrep” pills that I would have to consume before the procedure as a laxative. I can buy 500 grams of laboratory reagent grade monobasic sodium phosphate from Sigma Aldrich for $89.30… That means that my prescription’s active ingredient was marked-up Two Thousand 40 percent, ($166.43), for measurement, packaging into pills, distribution, overhead, and profits.

    2). I recently had to go in for a consult with an internist at my PPO in order to get the referral to a gastroenterologist for the colonoscopy. While I was there I got a tetanus booster. The PPO charges were:
    CHARGED: Doctor Appointment=$142, Tetanus Booster Vaccine = $76, Nurse to Give Injection = $45
    INSURANCE ALLOWED CHARGES OF : Doctor=$98.01, Tetanus Booster=$32.01, Injection=$24.91
    MY COST: $56.92 (immunizations are deductible in my insurance).

    Its interesting to note that prior to the ACA I could have received the tetanus booster for $10 from my county health department. Before I got my present insurance (which is significantly cheaper), I could also have called a gastroenterologist directly for a colonoscopy appointment obviating the $98.01 doctor charge paid for by my insurance.

    1. baffling

      mark s, just a couple of comments:
      1. “That means that my prescription’s active ingredient was marked-up Two Thousand 40 percent, ($166.43), for measurement, packaging into pills, distribution, overhead, and profits.”
      you are not buying active ingredients with proper oversight for human consumption, most of those chemicals are for research and development purposes. they are not therapeutic purity-that costs money.
      2. “Its interesting to note that prior to the ACA I could have received the tetanus booster for $10 from my county health department. ”
      this is a government subsidized price for the tetanus booster. also your requirement for a referral to the specialist is a function of your insurance company policy, not ACA. over the past couple of years my own insurance has also modified the referral process so i do not need my pcp as a referral-saves me money.

      i agree with you that the health care system needs improvement. it is very far from a free market system with price discovery. but it is not an easy system to introduce price discovery, particularly in emergency situations.

      1. MarkS

        baffling-
        1. The reagent grade monobasic sodium phosphate sold by Sigma Aldrich is 99.05% pure and is the same stuff used in packaging the OsmoPrep pills. Its just a laxative, “therapeutic purity” is in this case just a paper tiger. 纸老虎 !
        2. The $10 charge from the county was not subsidized. The public health nurse is still employed there, and is paid for by my property taxes. She still performs childhood vaccinations. The tetanus vaccine was purchased by the county from the US Health service at the bulk price of the vaccine manufacturer plus shipping… What wasn’t subsidized before was the markup.
        3. The referral to the specialist for a diagnostic test is indeed a stipulation of the insurance company in it’s policy contract. However, these terms were negotiated by the insurance company with the PPO for exclusivity. In other words, the consumer pays out-of pocket for the referral privilege to a diagnostic procedure recommended for everyone over 50 years of age! The PPO collects free money for basically doing no work. The “consideration” in this case, is that the insurance company gets to hold the PPO to a pre-negotiated CPT code price list.

        1. MarkS

          ….Correction:
          “the insurance company (not the consumer) pays out-of pocket for the referral privilege….”

        2. MarkS

          … Current list cost for an adult dose of “Tetanus and Diphtheria Toxoids” for the CDC ranges from $12.59 to $13.68 per dose from a 10-pack.. The CDC lists the “private sector” price at from $17.99 to $21.74 per dose from the same 10-pack…. That means that the $76 price from the PPO for the vaccine as marked up from 250 to 322 percent. SUCH A DEAL !

        3. baffling

          mark, the issue is the liability of the chemical sold. i would bet the material sold by sigma aldrich states a purity, but also has a catch that this is not adequate for human consumption. somebody has to pay for the liability that if taken by a person, it is not contaminated. that costs money. your gripe is probably more with the lawyers than the medical professionals in this case.

          whether you realize it or not, your vaccination was subsidized. the cost of the vaccine, delivery and storage, plus health professional time. you only pay $10 at the time of the visit, but it costs more to administer the vaccine-see the private sector charges. the local health center purchases the product from the us government at subsidized prices as well. at the county level you are pooling the resources from thousands of residents each paying into the pot and sharing the combined resources. so you claim the health professional was paid for by your taxes. if i live in your community, then the professional has been paid for by my taxes as well. since i did not get a vaccine, i received no benefit. but i still paid into the pot. you were subsidized by my taxes.

          1. MarkS

            baffling-
            You’re still missing the point: The Sigma Aldrich chemical is exactly the same chemical that is sold under pharmaceutical trade names. The only difference is the packaging. Relative to vaccinations in my county, I do concede that everyone’s property taxes whether directly paid or indirectly through rent, subsidize the county public health department. Citizen’s benefits are not limited only to their own immunization however. Benefits are accrued by everyone by preventing: epidemics and increased loads on social services. What’s really important here is that the private sector PPO list price for the immunization was 1000% higher than the government price. This is a classic example of private commerce price gauging compared to low-cost no-profit public services.

            I very much doubt that you support elimination of government subsidy of highway construction, communication, or defense… I think that you’ve been watching too many old John Wayne movies and are confusing libertarianism with common sense.

          2. MarkS

            baffling-
            One update: I just found out that Monobasic Sodium Phosphate as used as a laxative is patented, and has been assigned twice, first to Salix pharmaceuticals, then to Jefferies Financials. It would appear that part of the 2000% markup can be accounted for by patent lawyers, clinical trials and investment bankers. (More regulatory monopoly). The bad news is that this patent is very recent, published in January, 2012.

      2. anon2

        I agree with Mark S. “the elephant in the room remains the unconsciously high price levels and markups for drugs and medical services”

        He is 100% correct. The medical industry in America is over priced and under performs and as far as I can tell the ACA does little or nothing to address these monumental issues.

        I would go even further to argue that the medical industry in America is not designed to help patients as much as to extract payments from patients. If you happen to get better, well sometimes that happens.

  4. baffling

    obamacare has managed to include nearly 17 million people within the ranks of the medically insured! not sure if it is politically feasible to argue going into the next election cycle, that for the betterment of america i want to repeal the ACA. taking away medical insurance is not going to be a good political platform in the future. my bet is even if republicans were to gain a majority which could repeal ACA, they won’t do it because of the long term damage to the party. you saw their bluff called on the debt ceiling, and the same thing would occur again over the ACA.

  5. AS

    RE: Healthcare & The Market System
    To some it seems that medical savings accounts could help medical care consumers become shoppers an thus help to instill some element of the market system into the healthcare market.
    Why does there appear to be resistance to fully implementing medical savings accounts perhaps as an adjunct to Obamacare?

    1. 2slugbaits

      AS Is there any law that prohibits people from setting aside a certain amount of money each month and calling that a “Medical Savings Account”? I don’t think so. Of course, what you’re really asking for are special savings accounts with tax advantages; that is to say, you want lower middle class workers to subsidize the health savings accounts of upper middle class workers. Far from instilling “market discipline” medical savings accounts will tend to drive up medical costs for the same reason that “Cadillac” health insurance policies drive up costs. Medical Savings Account has a nice Booth School approved free-market economics ring to it, but scratch below the surface and it’s just another rent seeking scheme. Just another way that Rep. Paul Ryan tries to comfort the comfortable and afflict the afflicted.

      1. AS

        2slugs,
        I appreciate your response. I am not interested in lower middle class workers subsidizing upper middle class workers. I am interested in patients “shopping” for the best health service value. Perhaps folks below a certain income level could have a version of an earned income credit placed in a health savings account for them by government, so, in fact upper income folks would be subsidizing them. Having spent a significant part of my career in providing health care that competed with hospitals, I have some experience in providing both home IV therapy and outpatient surgery center services at a fraction of what hospitals charge (starting about 1982 when such services were “new”. When I was first involved with home IV services, we offered home IV therapy at $100 per day to compete with inpatient hospital equivalent services costing $1,000 per day. We had 200 locations in 44 states. Similar patient charge advantages were offered to outpatient surgery patients. I envision that motivated health shoppers would seek the best value at the lowest cost and that this behavior would incentivize entrepreneurs to offer competing health services at lower costs than may exist today. I was actively involved with lowering health care costs through the market system (with excellent health outcomes), not through edict.

      2. Patrick R. Sullivan

        ‘Of course, what you’re really asking for are special savings accounts with tax advantages….’

        Right, we should treat them just like employer provided health insurance. No tax advantages at all.

    1. baffling

      anonymous, i am not off at all. obamacare has affected 17 million people directly with its provisions. i did not say it brought in 17 million uninsured. but it has put 17 million folks into a protected position with respect to health insurance. vast improvement over the millions of people who previously could have been dropped when the insurance companies decided they were no longer financial cash cows.

  6. Rick Stryker

    2slugbait’s faith was not misplaced. His forecast of 6-6.5 million sign ups turned out to be very accurate. Based on the trend, I along with many others thought it might get to about 5.2 million. So kudos to him. With the actual 7 million sign up number, Obamacare supporters far and wide are celebrating. Is Obamacare OK now? Is it now working?

    Nope. These sign up numbers mean that patient Obamacare has been upgraded from being on life support to being seriously ill. I’m happy that more people got insurance than looked likely at the beginning of March, but the policy is still a failure. And Sen Barraso is correct that these marketing numbers represent cooking the books.

    Of course, in order to discredit Sen Barraso, his comment is being twisted into a claim that he didn’t make: that the 7 million signups are somehow made up. But if you watch the video that’s not what he was saying. Rather, he was saying that the 7 million signup number is not the relevant information that we need to judge how well the program is working. Understandably, the Administration is withholding the relevant information.

    In maelstrom of the botched rollout, people gradually forgot what the original CBO estimate actually meant. The press and the Administration came to interpret it as the number of people who signed up for a plan on the web site. But that’s not what the CBO was predicting. If you look at their table in their May 2013 estimate, you can see that 7 million was the net increase in previously uninsured people that obtained insurance on the exchange. It was not the number of people who hit the “buy” button. The number did not include the previously insured. It did not include those who didn’t pay. And it was not the number of people who signed up by March 2014 but rather the number of newly insured people who on average maintained insurance coverage over 2014.

    The table indicates that the CBO expected that the net increase in previously uninsured people to obtain insurance from Medicaid and CHIP would be 9 million. It also expected that employment changes would be a wash and that non-group coverage would decline by 2 million, so with an increase of 7 million in insurance coverage on the exchanges a net 14 million fewer people would now be uninsured under the law in 2014.

    Did any of this happen? Reports suggest that a substantial number of the enrollees on the exchange previously had insurance. Since the employer mandate was delayed, did 7 million new people enroll in employer-offered ACA-compliant insurance as the CBO expected in footnote “e”? If not, did we get no net increase in non-Medicaid insurance coverage?

    Senator Barraso should be commended for calling out the Administration for providing marketing data while withholding the real data on whether the law is working as intended. Besides information on changes in the number of the uninsured, people also want to know the benefits and costs. To what extent are people’s choices of doctors and hospitals restricted or not? How much are people paying? Are the chronically ill who were in high risk state pools better off or not? How high are deductibles? Are the demographics of the risk pools sustainable or are premium increases coming? That’s what Sen Barraso wants to know. And so do a good many voters. But all they get from the Administration is marketing numbers.

    The Administration understood how dispirited its supporters were and delivered a much-needed cheerleading boost with these marketing numbers. I’d be dispirited too if I were an Obamacare supporter, given the disappointments and broken promises. Obamacare caused such an uproar that the Administration was forced to delay key parts of it. The website rollout was very embarrassing and people didn’t get that promised $2500 reduction in premiums. If you like your doctor, you learned that you may have to get used to another one. Maybe you can keep your current plan; maybe not. Maybe they will enforce the insurance penalty; maybe not. The fact that the Administration achieved a meaningless sign up rate doesn’t change any of that.

    It’s nice to take a break and celebrate I suppose, even if for a short time. Sorry for the buzzkill, but the shellacking in November is still on schedule.

    1. Menzie Chinn Post author

      Rick Stryker: You are indeed a poster child for the paranoid view of the world. I congratulate you on conforming so completely to stereotype. If Barrasso meant “witholding numbers”, he would have said “witholding numbers”, not “cooking the books”, which implies the 6 million number is made up. In any case, thanks for re-hashing items pointed out in footnote [3] of the text.

      1. anon and lazy

        Menzie and the 2slugs = the Pajama Boy and Richard Simmons of Obamacre. Poster boys for the left’s war on the middle class.

        If you like your health insurance policy, you can keep your health insurance policy. And if you like your doctor, you can keep your doctor.

      2. Patrick R. Sullivan

        ‘I congratulate you on conforming so completely to stereotype. ‘

        The Self Awareness Quotient here continues its sad decline.

  7. Joseph

    Rick Stryker said: “If you look at their table in their May 2013 estimate, you can see that 7 million was the net increase in previously uninsured people that obtained insurance on the exchange. … The number did not include the previously insured.”

    Sorry, Rick. You obviously misread the table. The table clearly shows that the CBO estimated that 2 million people would leave their previous individual insurance (nongroup) but would be picked up by increases in either Medicaid or the exchanges. One way you could look at it is that up to 2 million of the 7 million in the new exchanges might have had previous insurance. The 7 million the CBO projects for the exchanges includes both previously insured and uninsured. It is incorrect to say that 7 million is a net number. The only meaningful net number is the sum at the bottom, a 14 million reduction in uninsured.

    1. Rick Stryker

      Joseph,

      Yes, you are right. It’s hard to tell from the Table what the CBO’s assumptions were but in general that 2 million decline in nongroup could have been split between employer-provided insurance, Medicaid, and the Exchanges. So, I’d agree that the CBO was not implying that all of the increase on the exchange would necessarily be newly insured; At most 2 million would not be. Thanks for pointing that out.

      It will be very hard to sort all this out given that the Administration allowed nongroup people with pre-ACA insurance to keep it as well as provided a special exemption from buying exchange insurance if they deem it “unaffordable.” In the list of numbers that would interesting to see is whether there was any decline in the insurance level of people who previously had insurance, since they were given the ability to opt out.

  8. Anonymous

    Joseph,

    Yes, however, at very least the CBO is predicting 5 million new, previously uninsured americans getting coverage from the exchanges. Sorry, but you hit about 20% of that goal.

  9. baffling

    rick stryker,
    your rant is simply full of excuses for why you have been wrong about obamacare. it is simply a sign of a sore loser. through the obamacare program we have improved the health insurance position of 17 million people. you are opposed to this achievement. someday you will have to explain to your maker why you had the opportunity to help those around you who were in need, but instead chose a path of denial. for your sake i hope you will come up with better excuses than those you have posed on this blog in the past.

    1. Hans

      ” obamacare program we have improved the health insurance position of 17 million people.”

      I suspect you could only make this statement by suggesting that most of these people will
      be receiving free health care policies or heavily subsidized ones…They are the only ones
      whom will save the promised $2500.oo per year.

      And again I axe, if BarrockOcare is such a cost efficient program why does it need to be
      enforced with Police Powers and mandates?

      I thought the left supports individual freedoms or is it just the freedom to impose your
      cherished social programs upon your fellow Americans? Really, which is it?

      1. baffling

        hans, you and W and the conservative caucus owned Congress for several years and did nothing to help the health insurance programs, other than buying senior citizen votes with the medicare prescription plan. you missed your chance to fix the system. crying foul now is simply the sign of a poor loser. you had your chance and you punted. somebody else picked up the ball and scored a touchdown. deal with it!

        1. Hans

          Your Baffship:

          Please do not associate me with any of the Bushnecks…

          You are correct, three session of control of the Duma and a record
          $400 billion + deficit..(notice conservation reaching across the isle
          and crediting his foe)

          You failed to answer either one or both of my questions posed to you..
          Why, am I not surprised?

  10. Hans

    This is the most deceptive, incompetent White House and CONgress
    since the founding of this nation..Lying has become an acceptable
    policy as the means to justifies the end.

    Notice that BOCO’s pronouncement came on April 1, Fool’s Day which
    I find very appropriate.

    An unbelievable 76% of Demcos still support this complete failure of
    an administration…

    Barrocko, is right about one thing, there will be consequences as it will
    fall upon Americans and their economy and their way of life…

    1. Hans

      Mr Hurley, the your link is not functioning…Just weeks ago, the Secretary of the Welfare Department
      was asked how many “folks” had register for BarrockoCare, she could not supply any data.

      Then a day after the end of sign up deadline, a flow chart appears with a multitude of data all of
      which confirms the “near” success of the programs goals.

      I may be an illiterate, but the sudden convenience of meeting official goals does not escape me.

    1. Hans

      Ricardo, I doubt that was Professor Chinn’s intent nor statement.

      Besides, let us Conservatives not engage in what is
      the left’s foundation for their advancement of political
      power.

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