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OPINION: 24 million to ‘lose’ insuance? Not so fast


How to explain the projection that 24 million Americans would become uninsured if the House GOP’s heath-care plan becomes law? Easy: Garbage in, garbage out.

There are good reasons to believe the plan, dubbed the American Health Care Act, is not the best idea. But the Congressional Budget Office’s estimate of its effect on insurance coverage is not one of them. Not because the fates of 24 million people are unimportant, but because it’s highly doubtful we’re really talking about 24 million people.

The CBO reported what it believes would happen if the AHCA became law, relative to what it believes will happen under current law — i.e., Obamacare. And history shows the CBO has consistently been wildly wrong about Obamacare.

Consider that, on three occasions, the CBO projected enrollment in health-insurance plans offered on the Obamacare exchanges in 2016 would surpass 20 million. In reality, the actual number was closer to 10 million, according to figures reported by health-policy wonk Avik Roy in Forbes. So the CBO’s original projections were off by 100 percent.

Last year, the CBO recalculated its projections, bringing them closer to reality but not all the way there. For example, its estimate for this year was 15 million enrollees; the real number, Roy reports, will be about 11 million.

For next year, the CBO forecasts enrollment will hit 18 million, and remain that high through 2026. That’s almost certainly wrong. Think about it: If the exchanges are really going to see such strong growth, why are so many insurers jumping ship? Many regions, including parts of Georgia, are down to one insurer still participating in the exchange. That wouldn’t have happened if insurers expected enrollment to soar.

Now the CBO is using these faulty estimates to predict the AHCA’s effects. And guess what? All those people who haven’t bought Obamacare plans are now being counted — but as people who won’t buy insurance under the AHCA.

That’s right: As many as 8 million people, out of the estimated 24 million people who would “lose” insurance under the AHCA, aren’t buying insurance now. They’re only “losing” insurance if you believe they were going to start buying it even though premiums for exchange plans continue to rise.

But wait, it gets better. The CBO also estimates millions will lose coverage due to the AHCA’s partial rollback of Obamacare’s Medicaid expansion. But about one-third of these, as many as 5 million people, live in states that haven’t expanded Medicaid. Why did the CBO include them in its estimate? It thinks those states might have expanded it one day.

Taken together, at least half of those estimated to “lose” insurance under the AHCA are uninsured today. Even the remaining number of about 12 million is misleading, because the CBO says many of them would simply choose not to buy it once the individual mandate is eliminated. The actual number of those newly uninsured against their will may be as little as 5 million.

That’s still a big deal to them, of course, but they may benefit from the new bill’s efforts to make the insurance market more dynamic — provisions the CBO’s static scoring model does a poor job of capturing.

Either way, that’s a much smaller group to focus on than we’ve heard about so far.



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