With Obamacare enrollment, the devil is in the details

Two new reports about the impact of the Affordable Care Act are casting a shadow over the much-ballyhooed Obamacare milestone of 7 million HealthCare.gov enrollees.

The first, from RAND Corporation, a nonprofit think tank, looks at the composition of newly insured Americans and adds much needed context to statistics widely touted by liberal Democrats.

“We see that of the 40.7 million who were uninsured in 2013, 14.5 million gained coverage, but 5.2 million lost coverage, for a net gain in coverage of approximately 9.3 million,” researchers Katherine G. Carman and Christine Eibner write.

Setting aside the collateral damage of 5.2 million people losing their plans, as they were explicitly told they would not, 9.3 million newly insured via Obamacare seems like quite an accomplishment, even if some 25 million Americans still lack insurance.

However, the majority of the newly enrolled population did not go from uninsured to private insurance. Nearly six million people have been enrolled in Medicaid, and not just because of states that expanded the medical welfare program. A significant amount were already eligible for Medicaid but did not enroll until they found their way to HealthCare.gov.

As Edward Morrissey writes at Fiscal Times:

While the White House can claim credit for a net increase of 9.3 million insured and a lowered uninsured rate from 20.5 percent to 15.8 percent, the data provides a significantly different picture than that painted by President Obama and the ACA’s advocates.

First, a significant amount of this increase comes from Medicaid enrollments, not private insurance. Almost six million people enrolled in Medicaid, and earlier studies showed that a relatively small number of those came from the expansion built into the ACA; most of these would have been Medicaid-eligible prior to the reform.

Another 8.2 million more people enrolled in employer-provided health care, as 7.1 million left the “other” category and another 1.6 million left the individual insurance markets. Only 3.9 million actually enrolled in insurance plans through state or federal exchanges – not 7.1 million as claimed by Obama. That number falls far short of even the lowered expectations issued by HHS and the White House earlier this year.

The second study, from Express Scripts, a pharmacy benefit manager, suggest higher than expected premium increases may be on the horizon due to the medical needs of incoming enrollees.

Morrissey writes:

Their new study shows, for instance, that the enrollees from state and federal exchanges have a 47 percent higher use of specialty medications than in commercial plans in general. “Increased volume for higher cost specialty drugs can have a significant impact on the cost burden for both plan sponsors and patients,” the report reminds readers. “Despite comprising less than 1 percent of all U.S. prescriptions,” the report continues, “specialty medications now account for more than a quarter of the country’s total pharmacy spend.”

The medications themselves show that the care costs will increase relative to the existing risk pools as well. The rate for HIV medications in Obamacare exchange plans is four times higher than in existing commercial plans. Medication prescriptions are 35 percent higher, and anti-seizure medication increases 27 percent. Ironically, the only category where exchange consumers have lower demand than commercial-plan customers is in contraception – the focus of a big political battle in the employer mandate.

As Express Scripts, which studied changes in pharmacy benefits concludes that the ACA has succeeded in getting coverage to consumers who need it. However, that comes at a high cost for those who had their existing coverage canceled and saw their premiums and deductibles skyrocket as a result of Obamacare. Furthermore, the number of those who gained coverage may be even smaller than the RAND study concluded.

Of those who enrolled in an exchange plan, Express Scripts finds, 43 percent already had Express Scripts coverage in 2013 – and at least some of the other 57 percent may have had coverage under another prescription-medication management service. If the total number of actual exchange enrollees is 3.9 million, the final number of previously uninsured exchange consumers may be only as high as 2.23 million.

Although liberals, with an eye toward November, would like to think the debate over Obamacare is finished, the health care law’s sweeping impact on American life virtually guarantees that it will be debated for the next few years. For congressional Democrats, this is bad news, indeed.