Repealing ObamaCare Costs How Many People Coverage?

Those who advocate the retention of ObamaCare are claiming highly exaggerated losses of coverage due to its repeal.  They assume that no new coverage will come into play upon its repeal.  HHS Secretary Burwell cited a claim that 30 million Americans will lose their coverage.  Many others are claiming that 20 million will lose their coverage.  These exaggerations are exactly as I predicted here.

First, as I noted here, only 11.1 million people were covered for the year in 2016, though 12.7 million signed up for coverage on ObamaCare health insurance websites.  They are very trusting people to sign up and to provide their social security numbers on those very incompetent exchanges.  But I digress.  The lower 11.1 million people number is found by adding up the monthly premium payments and dividing by 12.  But you can be sure that the advocates of ObamaCare use the 12.7 million number and have no regard for the fact that the 6 million who lost coverage due to ObamaCare are now proportional to the population growth as 6.1 million who would have been happy to stay on their old plans, especially now that they will have to soon make more changes due to the many instabilities that ObamaCare has introduced.  Subtract 6.1 million whose loss of insurance the ObamaCare advocates originally did not care about from 11.1 million and one has only 5.0 million on ObamaCare of new enrollees.

The ObamaCare insurance loss alarmists count all of the new enrollees on Medicaid compared to 2013 as being covered by ObamaCare as well.  As I noted here, of the 17 million new enrollees into Medicaid in 2014, only 3.3 million were newly eligible for coverage as a result of state expansions of Medicaid benefits as a result of ObamaCare.  It is clear that the claim that 30 million will lose their insurance comes from adding 17 million added people on Medicaid to 12.7 million who paid some portion of their premiums on ObamaCare purchased insurance in 2016.  It is also clear that this is a very dishonest number.

A more honest number is that of adding the additional 5.0 million insured under ObamaCare exchanges from the fully paid premium equivalent number to the 3.3 million added due to the expansion of Medicaid coverage by states under the ObamaCare law.  That gives us 8.3 million people.  But even that is dishonest.

Why?  One of the reasons this is dishonest because in 2014 alone employers dropped the health insurance coverage of 2 million people under their employer plans.  Small businesses alone dropped coverage for 2.2 million people as a result of ObamaCare and some unknown degree of reduction due to the super-extended poor growth Obama economy, some of which is also due to ObamaCare.  What is more, prior to ObamaCare, the number of people covered under employer plans had expanded year after year, so that growth in employer coverage was lost.  So, conservatively, we subtract another 2 million from the number of people who will lose coverage due to the repeal of ObamaCare.  We are now at 6.3 million people.

But in reality, these 6.3 million people will have the option to go without health insurance after the repeal, which may be wise if they are healthy or so rich that they can reasonably be self-insured.  In 2017, the wealthy will not be able to afford to lose 2.5% of their income to ObamaCare penalties, so they will have to buy ObamaCare health insurance no matter how little they need it, unless it is repealed.  Then ending ObamaCare will bring many employers back to offering insurance plans for their employees.  Many more cost effective private plans will come into existence, once the ObamaCare straitjackets are removed.  ObamaCare requires too many doctor visits and doctors offer much less treatment per visit since it was passed.  This is the usual practice with government-controlled health care.  It becomes very inconvenient, so people use it less and get less for the cost of the coverage.  Without ObamaCare, there will be a return to competition in the medical insurance market as well.  Most areas of the country now have only one or two insurers offering ObamaCare health insurance plans.  This is not good for costs.  High costs keep many from enrolling in health care insurance.

So, if the Republicans do nothing to replace ObamaCare, the net number of people losing health insurance will be fewer than lost it when ObamaCare was put in place.  If 6 million people happy with their insurance then did not matter, how can the advocates of ObamaCare claim that the less than 6 million people dependent upon ObamaCare will matter now.  In fact, the repeal of ObamaCare does not mean that those people added to Medicaid due to its expansion in some states will not continue to be covered by Medicaid in those states.  That 3.3 million people were almost entirely the responsibility of the states after 3 years under ObamaCare in any case.  2016 was the third year. Federal subsidy payments were scheduled to plummet in 2017 anyway.  This is why many states did not allow themselves to be hooked into expanding their Medicaid rolls.  So, the repeal of ObamaCare will actually result in fewer than 3 million people losing their health care insurance relative to the before ObamaCare number.

Only Democrat Socialists can get away with pretending that fewer than 3 million people are 30 million people or sometimes only 20 million people.  These are the same people who claimed that 47 million Americans were uninsured before ObamaCare and then in 2014 stopped counting the many millions of illegal immigrants as among those uninsured to make ObamaCare look as though it was much more effective in providing health insurance than it actually was.  Tricky Dicks, these socialists.  Too bad we do not have a free press willing to keep them honest.

ObamaCare Continues to Lose Altitude with Crash Inevitable

The biggest problem with ObamaCare is the loss of the fundamental ownership of your own mind and body. ObamaCare is primarily a declaration that no one has individual rights. According to the ObamaCare philosophy one is nothing but an infinitesimal part of the Collective. Some persons in the Collective did not have health insurance or had health insurance that was not approved by the Regressive Elitists who controlled the government with a claim as benevolent caretakers for the unwashed masses  such as you and me.  That claim bears a great similarity to that of the aristocracy of medieval times to the Divine Right of Kings and Aristocrats justified by their supposed service to the People.

ObamaCare caused millions of Americans to lose the insurance they were happy with.  They were forced to pay higher premiums, higher deductibles, travel greater distances, and accept lower quality health care than they previously had. A recent Mercatus Center study reveals that qualified individual health plans had claims to premium income ratios of 1.10 in 2014, while non-qualified individual health plans had claims to premium income ratios of 0.83.  The group qualified health insurance claims to income ratio was 0.82.  To cover the cost of claims, individual qualified health insurance plans would have to have had premiums about 30% higher than they were.  Many insurers have stopped offering ObamaCare qualifying individual health insurance plans in many states due to these unsustainable losses.  Those who have continued to offer plans have done so with some combination of increased premiums, increased deductibles, and narrower and narrower networks of providers.  In many areas of the country, patients have to travel much greater distances for the limited health care their health insurance provides.

The chart above is from a Kaiser Family Foundation report of November 2015.  The average percentage of uninsured less than the age of 65 in the pre-recession years 2000 to 2007 is 16.5%.  The 2014 uninsured rate for the non-elderly population, including illegal aliens, has been reported to be down based on interviews.  In January 2014, a Gallup poll found that 16.1% were uninsured.  In September 2014, the New York Times reported that the number of uninsured fell by 8% in the first quarter of 2014 compared to 2013, which would make the percentage of uninsured about 15.4% or only 1.1% less than the pre-recession average for 2000 through 2007. A CDC study based on interviews from January to September of 2014, claimed the nonelderly uninsured rate was 13.3%.  The government has a history of exaggerating the insured rate of coverage since ObamaCare was passed and people now have reason to fear telling a government agent that they do not have qualified health insurance, so the federal interview technique may be inclined to return a low value for the uninsured. In addition, having been forced to sign-up for health insurance many do not want and do not think they can afford, many do not actually pay their insurance premiums.  The only reliable way to determine how many people are insured is after the year is over and the insurance companies report on how many they had insured, but such data does not yet seem to be available.  ObamaCare supporters often like to attribute the decrease in the uninsured due to the glacially slow recovery from the Great Recession to ObamaCare, so this reference to the fairly stable uninsured rate prior to the recession is important if one is not to overstate the effect of ObamaCare on reducing the percentage of uninsured.

Many of the newly insured are actually those wealthy enough that they had very reasonably self-insured themselves and their loved ones, but are now forced by ObamaCare tax penalties to buy the insurance they did not need.  The very small reduction in the uninsured was also accomplished in large part because the rates being charged in 2014 were much too low and unsustainable.  Premium rates went up dramatically in 2015 and again in 2016, and will go up dramatically again in 2017, even as deductibles have continued to rise for many and health insurance choices have greatly diminished.  Some large insurers in Georgia are planning 65% premium increases in 2017, while some in Pennsylvania plan increases of 38%, some in New Mexico 32%, and some in Oregon 30%.

That small 2014 decrease in the uninsured rate will not be maintained. Young and healthy people cannot continue to subsidize less healthy people by taking on ever-rising insurance premiums they cannot afford even as they cannot benefit from the insurance for many of their health needs because they have insufficient money left to also pay the ever-increasing deductibles.   Even in 2014, the young and healthy were failing to provide the support to ObamaCare that it critically needed and their rapidly rising health insurance costs will inevitably result in more and more healthy people choosing the ObamaCare tax penalty over qualified health insurance.  Meanwhile, many insurance companies are trying to sue the government to make the government cover their losses.  The only way these insurers are likely to be reimbursed their losses is if the Democrats regain control of the House of Representatives.


ObamaCare was always insane and unsustainable, as programs tend to be that ignore the essential fact of the individuality of humans and their sovereign individual rights.  Just as the aristocracy of Medieval times failed most of the people most of the time, so are the Regressive Elitists of our time failing most of the people most of the time.  It is impossible for self-proclaimed elitists to competently manage the lives of those they do not even know.  Just as the aristocracy of Great Britain failed to manage the American colonies competently in the 1760s and 1770s, our hone-grown aristocratic elitists of the Obama era cannot manage the health needs or anything else essential to the American individual of today.  A real Declaration of Independence from a government dominated by a self-proclaimed aristocratic elite and their chosen special interests, such as the health insurance companies who in 2009 backed ObamaCare, is long overdue in the struggle for the interests of the individual and his much maligned sovereign rights.

Update on the Uninsured

Michael D. Tanner, a senior fellow at the Cato Institute, has updated us on the uninsured Americans, who according to the Census Bureau number 45.6 million. I have dealt with this issue of the uninsured in previous posts on 25 November 2007, 23 July 2008, 27 August 2008, and 29 August 2008.

The story now is similar. The uninsured are:

• 12 million eligible for Medicaid and the State Children's Health Insurance Program, including 64% of uninsured children and 29% of parents with children. If these people go to a hospital for treatment, they are automatically enrolled in the relevant program, so they are not really uninsured!
• 10 million who are not citizens of the United States, where 5.6 million are illegal immigrants and 4.4 million are legal immigrants.
• 43% of the uninsured have incomes greater than 250% of the poverty level or greater than $55,125 for a family of four. More than one-third have incomes over $66,000.
• Nearly three-quarters of the uninsured can afford health insurance coverage.
• 60% of the uninsured are under age 35 and 86% say they are in good or excellent health.
• About half are uninsured for less than 6 months, 30% for less than one year, 16% for less than 2 years, and less than 2.5% for 3 years or longer.

Tanner then says that with this information in hand, we should be able to produce a more focused plan to address the issue of the uninsured. The young and healthy who choose not to have health insurance, would be more willing to buy it if their premiums were not jacked up by community rating [plans have to accept the already ill, those with unhealthy lifestyles, and the old] requirements often required by the states, by eliminating the many mandated benefits that many people do not need or want, and by allowing people to buy insurance across state lines [in the spirit of the interstate commerce clause of the Constitution].

The generally short durations in which people do not have health insurance suggest that many lose it when they lose or change jobs. Some lose it because they have started a small business and current tax policies exclude many small business owners from tax deductions for health insurance. The best way to deal with this is to give everyone a large Health Savings Account (HSA) to purchase health insurance, but the Democrats hate this for no reason but that it removes health care decisions from politics and deprives them of political power. A great advantage of the HSAs is that they give health care users a reason to care about the cost and effectiveness of the health care they seek from providers. In the government-run system, no one has such reasons for personal interest so costs balloon.

Democrats claim that the massive health care overhaul is needed to address two issues:

• The many uninsured.
• The ever-increasing cost of health insurance.

Their answer is to create a new, government-run system which will force everyone to buy much more expensive health insurance than that bought by most people today. This will hit the young and the healthy the hardest. Then they will force the wealthier to pay for the insurance that the less wealthy are already buying or could buy at present prices. Of course, the unfunded Medicaid and Medicare programs will remain inadequately funded and will require either a huge future rationing of health care or huge additional taxes. This makes no sense at all, but never let it be said that Democrats are ever constrained by rationality. Demagoguery is so much more emotional fun. It is so easy to make people imagine that 47 million Americans are so poor that they cannot afford health insurance and they live for decades in terror of becoming ill without any way to pay for care.

The Misunderstood 47 Million Uninsured

Over and over again, we are told that there are 47 million uninsured Americans. My own simple-minded Senator, Ben Cardin of Maryland, just wrote me an e-mail note attempting to justify the Children's Health Insurance Program with the opening sentence of "Currently, more than 47 million Americans lack insurance coverage and approximately 9 million of the uninsured are children." Then he and many others claim that health care is too expensive for Americans. We are to uncritically assume, and it appears that most of us do, that the 47 million uninsured Americans are uninsured because they cannot afford adequate or even inadequate health insurance. But, worst of all, this is a play upon our good nature and our concern for the welfare of other Americans, which is supposed to imply that if we wish to be a good person, we must be willing to consent to a partial enslavement of all of us and an extensive enslavement of health care professionals so that 47 million desperately poor Americans will have health care.

Charles, you say, it is outrageous that you equate proposed government-provider systems that would tax us all and then spread the health care benefits over all or some favored sub-group of Americans with partial enslavement of us all. And then you even say that the government regulation of the resulting health care system extensively enslaves American health care professionals. Just because we are going to force everyone to participate in this universal, one provider plan does not make it slavery. After all, we simply want to take care of those who cannot take care of themselves. To which I reply, when you do not allow people to manage their own lives, you have enslaved them. When you will not allow them to own their own life, the liberty to make their own choices, and to pursue their own idea of happiness, you have enslaved them. That you claim to be motivated by paternalism does not even differentiate yourself from the plantation owner of the antebellum South who often claimed he was taking care of those who could not care for themselves.

If there were 47 million Americans without health insurance and they could not afford it, then we would simply be in the situation of earlier times or of much of the rest of the world. But because we have had some respect for individual rights in America and we often claim that we believe in the right to life, liberty, and the pursuit of happiness, Americans have enjoyed a widespread prosperity which has greatly improved the lives of every income strata among Americans and has specifically delivered them the best health care system in the world. We provide a very disproportionate share of the medical innovation and win most of the Nobel prizes in Medicine, as well as those in the sciences, which often also support medical innovations. We develop a disproportionate share of the new drugs. Our medical professionals provide timely care for life-threatening medical problems which puts all of the basic care only and highly rationed higher end care provided by national medical systems in other otherwise advanced countries to shame. Canadians must come to the U. S. for many live-saving operations that Canada will schedule them for only after they are dead. This makes for an interesting approach to reducing the demand for operations which the state system would have to provide manpower and care for. Canada exports much of its medical expense to the U.S.

However, the 47 million Americans without health care insurance is a fraudulent figure. Of this 47 million, 10.2 million are not U. S. citizens. Of course, many of them are Americans, but only in the sense that they are citizens of countries elsewhere in the Americas! But this is not what most people are thinking when this figure is given. So, fewer than 37 million U. S. citizens are without health insurance.

The next important point is that many American citizens who have the means to buy insurance, choose not to do so. 8.5 % of those with household incomes greater than $75,000/year do not have health insurance. Of course, some fraction of these people have so much money that they are fully justified in regarding themselves as self-insured and there is simply no reason to pay a middleman. Bill Gates, Warren Buffet, and even The Donald have no need for health insurance. But, apparently a great many other people making good money do not need it either, although some of them do not have it simply because they are in the midst of changing jobs. There are 9.3 million of these well-off people. Then there are the rest of those who make more than the national average for a household and yet do not have health insurance. Of those households with incomes between $50,000 and $74,999 a year, 14.4% do not have insurance. This is another 8.5 million people. So, 17.8 million people can afford health insurance, but choose not to buy it. Again, many of this group are only briefly without insurance as they change jobs. A large fraction also goes without insurance because they regard themselves as too healthy to want to buy insurance to subsidize the health care of those who are less healthy! This is a manifestation of their pursuit of happiness. I have a nephew who has made this choice.

At this point, we are left with only 19.0 million Americans without health insurance. Of these, once again many are without health insurance only briefly as they change jobs. Some also are eligible for government health programs, but do not apply. John Stossel found that about a third of those eligible did not apply. Americans without health insurance make frequent use of hospital emergency rooms, which are required to provide them with medical care. They also use Medicaid in many instances. So, it is simply not the case that many millions of Americans cannot get medical care. Any implication that this is the case is fraudulent.

There are serious problems with our medical care system, but they will not be improved by making it a national system, if the problems rampant in Medicare and Medicaid can teach us any lessons at all. Or, if we can learn anything by examining the national health care systems of Canada or the United Kingdom. Our problem is that 86% of all American health care purchases are handled by third parties. This means that the patient has little to no incentive to demand cost-effective health care. The result is that little attention is paid to being cost-effective. My mother has a habit of asking medical care givers to justify the high costs of her and my Dad’s medical care and they very commonly are indignant that she cares. They say that she should have no interest in the matter, since she is not paying for it.

Another problem with our system is that it is so geared to the avoidance of legal suits, that one cannot get a straight answer from most doctors about almost any medical question. The profession has decided that certain procedures are to be considered acceptable practice and that if one stays strictly within those practices, then there should be no legal problems. This causes a different set of problems. For one thing, people are highly unique and what is statistically the most likely procedure to be successful, may well be the wrong procedure for a given non-conforming individual. Yet the doctor is unwilling to devise a procedure for the non-conformer, since to attempt to do so means he will have to leave the comfort zone of the accepted common procedure that protects him from law suits. In fact, I have heard of cases in which doctors gave advice they knew was wrong for a given patient, simply so they would remain consistent with convention. There are also cases in which the doctor believes that the chances for failure of a treatment are high and will not provide it even if that treatment is the only life-saving option for the patient. This is because to fail is to be open to a lawsuit.

So, if you actually do care about your fellow man, instead of making fraudulent claims about 47 million uninsured, do something to allow doctors and other medical professionals to really provide medical care without being totally paralyzed by fear of lawsuits. If you really care, let us change the tax code so that Americans will buy their own healthcare plans, be the guardians of their own costs, and be able to choose from many more treatment options which will be made available to them in a timely way.