By Chris Deaton Chris Deaton The Weekly Standard · March 20, 2017
In the hour it was reported with smothering ubiquity that the GOP’s Obamacare replacement would cause 24 million individuals to “lose” insurance, the debate about government health care policy was given a bucket of buffalo wings, a wet nap, and a day off. It was about to get sloppy and awfully lazy.
“24 million people losing insurance is roughly equivalent to the population of” 15 particular states, Rachel Maddow tweeted, not one of them with more than five electoral votes, but, when listed vertically, appeared ominous. Almost 50,000 users have hit the retweet button.
That’s 50,000 users who have participated in the week’s biggest question-begging exercise. Nowhere in the Congressional Budget Office’s projections about the American Health Care Act did the agency say the bill would cause 24 million to “lose” coverage—cancel it or take it from them. The report, rather, estimated that the total number of individuals insured under the Republican plan would eventually be 24 million fewer than the total insured under Obamacare. Why is that?
At the outset, it’s because some consumers would choose not to buy insurance if they’re not penalized for lacking it. “CBO and [the Joint Committee on Taxation] estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate,” the report reads. “Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.”
The Republican legislation would also make several changes to Medicaid, including its funding mechanism and the Affordable Care Act’s expansion of the program. “The reductions in insurance coverage between 2018 and 2026 would stem in large part from changes in Medicaid enrollment—because some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped,” the CBO explains. “In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”
The difference between 52 million and 28 million is 24 million, thus the number that has been reported in the media and weaponized by Democrats.
There are two takeaways from these two batches of yearly numbers. One, an individual does not “lose” insurance, like it was robbed or fell out of a coat pocket, if that person voluntarily chooses to forgo it. Such behavior is more likely when it doesn’t carry a fine. Some people might not want to spend their money on coverage; others might be priced out of purchasing it, the basis for many conservative critiques of the proposal that are beyond the scope of this writing. Two, those who are potential Medicaid enrollees cannot possibly lose Medicaid if they don’t have it in the first place. Democrats might say that such individuals are being deprived by the GOP’s action. But that’s for a separate policy discussion—one in which Republicans have their own ideas for how to provide poor Americans access to affordable health care. (See the passage on Medicaid and the AHCA from Avik Roy’s mercilessly headlined analysis.)
“Lose” does not have an appropriate synonym to convey what the CBO document projects for future health coverage. The agency’s forecast includes people who have varying motivations for being insured, as well as hypothetical consumers. And this stops short of the budget office’s difficulty in forecasting insurance ownership: a statistic based on human decision-making and, thus, substantial uncertainty.
All this is worth considering when House Minority Leader Nancy Pelosi says that the Republican proposal “pushes 24 million people out of health care, off of health coverage,” or when Senate Minority Leader Chuck Schumer says “the CBO of course made clear that 24 million Americans will … lose their health insurance if ‘Trumpcare’ becomes the law of the land.” The CBO stated no such thing. And as we’ve learned quickly, little of what it says comes off as “clear.”
There are several fair and honest critiques of the AHCA. This talking point from Democratic leadership is not one of them.