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September 08, 2014 07:47 AM MDT

Campaign Ads Criticize the ACA, But Are the Claims Accurate?

  • by: TheBell

(Facts beat fiction every time – promoted by Colorado Pols)

As it turns out, maybe not.
As it turns out, maybe not.

​Every time we turn on the TV, we see a new political ad opposing the Affordable Care Act. How do some of these claims stand up to closer examination?

Claim: 355,000 Coloradans have received cancellation notices for health insurance policies.

What you need to know: It’s true that thousands of Coloradans were notified in 2013 that their policies would not be renewed in 2014. Note the time frame: It was a one-time event, prompted by provisions in the ACA that required insurance policies to meet minimum standards.

Whether the letters were called “cancellation notices” – an incorrect term – or “non-renewal notices” – a more accurate description – the reason for the change in most cases was that the policies did not include the ACA’s 10 essential benefits. These include preventive-care services and coverage for pregnancy and mental health, and they are designed to ensure that Americans have adequate insurance for health emergencies.

Use of the term “cancellation notice” implies that customers were cut loose, left high and dry. In fact, because of the ACA, insurance companies were required to give customers the option of purchasing an alternative policy. Customers also had the option of buying a competing plan through the health insurance exchange. Those plans had the potential to be cheaper, and if a customer’s income was low enough, subsidies could make coverage even more affordable.

Also, after complaints and to help people navigate the new landscape, the Colorado Division of Insurance allowed policyholders to keep non-compliant plans through the end of 2015, as long as the carrier continued to offer them.

Finally, it’s worth remembering that the individual market was unpredictable for customers before the ACA. Insurance companies often canceled or changed policies every year, forcing families to scramble for new policies or settle for ones that often didn’t meet their needs.

Claim: On the Eastern Plains, patients outnumber their doctors 5,000-to-1.

What you need to know: This statement, plucked from a broader news story, is true for five counties in eastern Colorado. That’s about one-third of the counties east of the more populated Front Range. To put the number in perspective, the ratio in Denver is about 1,300-to-1.

But the larger issue is the implication that the Affordable Care Act is causing or significantly contributing to the problem. That’s not true, and in fact, provisions of the ACA are designed to provide more care in underserved areas. 

Recruiting and keeping primary-care physicians in rural areas has always been very challenging. Physicians there are likely to be paid less than their urban counterparts, and they are required to treat a greater number of patients with a wide variety of health problems. Also, specialists can be few and far between in rural Colorado.

In response, rural hospitals have to spend extra money to recruit and retain doctors, and that’s especially difficult when a very high percentage of rural patients have historically been on Medicaid or were uninsured.

Instead of making the problem worse, as the ad implies, the ACA is trying to help correct the problem. First, the ACA provides scholarships, loans and state grants in medically underserved areas to increase the provider workforce and support residency programs. Second, by expanding Medicaid, rural hospitals and doctors will see fewer uninsured patients, and that may improve the bottom line, making it easier to recruit and retain doctors. 

Claims: Health-care costs are still going up … Some rural residents pay up to 30 percent of their income for health insurance … Many Coloradans may pay 100 percent more for health insurance.

What you need to know: All of these statements suggest that the ACA is responsible for higher health insurance costs, especially in rural areas.

In reality, health care costs and insurance premiums have historically gone up every year. Between 1999 and 2009, before the ACA became law, health insurance premiums in the U.S. grew by an average of 133 percent.

The real question is whether coverage is more available and affordable under the law than without it. A recent report showed that the percentage of uninsured Coloradans dropped by six percentage points, from 17 to 11 percent, after the ACA took effect.

As for affordability, that depends on a number of individual factors, including income, health status, the specific plan and the level of coverage. For most people in the employer-sponsored insurance market, premium growth is about the same as it was before the law. For Coloradans with lower incomes who purchase insurance in the individual market, coverage may now be more affordable because of subsidies available under the ACA. Coloradans with pre-existing health conditions now have access to insurance coverage for the first time because those exclusions are no longer allowed.

Other factors that affect availability and affordability:

• Older policyholders can no longer be charged more than three times what younger policyholders pay for coverage.

• Women can no longer be charged higher premiums than men exclusively because of gender.
• Carriers have the right to pass costs associated with the two items above on to all of their other policyholders, and that may mean higher premiums for some.

• Some policyholders with higher incomes (who don’t qualify for subsidies) may pay higher premiums in the individual insurance market. As mentioned above, all individual health insurance plans now must cover the ACA’s 10 essential benefits. That can mean premiums are higher, but the coverage is better.

Insurance companies can still increase premiums in geographical areas where health care costs are high and provider competition is low. Since the ACA eliminated some of the rating factors described above, geographical rating now has a greater impact. As a result, premium rates in some rural areas have significantly increased, especially in ski resort counties. References to 100 percent premium increases (in Aspen and Pitkin County) and rural residents paying 30 percent of their income on insurance (in Summit County) mostly come from resort areas and do not reflect a statewide trend.

Health care has always been more expensive in rural areas. The cost of living is higher in rural resort areas like Aspen and Vail, populations in rural counties are disproportionately older and may need more expensive care, and many rural residents are employed in physically demanding or high-risk jobs. All too often, there is little incentive for rural doctors and hospitals to keep their prices low since they may be the only providers around.

The urban/rural and resort county/non-resort county divide may be less about the ACA and more about bigger issues that still need to be resolved. 

The bottom line is that in a health care system as complicated as ours, problems have multiple causes. And a single law can’t solve every problem. With these ads, it’s best to remember that they aren’t really trying to educate the listener or viewer. Rather, they are using selective arguments and trying to score political points.


21 thoughts on “Campaign Ads Criticize the ACA, But Are the Claims Accurate?

    1. Obama gave me a better policy.  Fucking liar ! 

      That's pretty much your argument, and it just looks more out of grips with reality every day Moddy, but hey, go with it.

    2. Mod for losers like DP, where we pay his premiums for him, his premium did go way down, maybe even $2500 per year.  But that is not what Obama said.  HS says Obama gave him a better policy.  HS is still looking for someone to take care of him. A generation ago, about 50% of our social spending went to the bottom 1/5 of society.  Now the bottome 1/5 gets much less and many more are dependant on the state, a cruel addiction if there ever was one.

        1. If we have to have this discussion AC, HS is at the top 1/5, works like a dog, and has been bringing in about 200 K a year for the past decade, supports a family, donates to charity, and is active in his community.

          But that doesn't fit your narrative, does it, you fucking imbecile.  HS has a problem with the middle class getting fucked over, because he's not a thoughtless little dick like you.

          And HS has done all of it without slobbering on the Koch like you, you worthless piece of shit.


            1. You don't deserve an answer. You're both too stupid and too worthless to justify the effort and not because we disagree with your views. You're simply the poorest excuse for a human being this site has ever seen.  Crawl back under your slimy rightie blog rock where there are plenty of equally worthless creepy crawlies to appreciate you. 

      1. trollboy,

        Betcha we don't see you turning down your social security checks or medicare once you're eligible. No, you'll self righteously proclaim that YOU earned it, you DESERVE it,  and it is YOUR money. As is the case with every other  working stiff out there.

        Or do you have plans to donate your earned benefits to charity? I'd bet real money on "no way, Jose", because you are "looking for someone to take care of you" in your old age.


      2. You obviousy have no idea what the cut offs are for subsidies, Piss Ant. A perfectly average middle income still qualifies for some level of  subsidy and average middle class people aren't takers or losers. I qualified and we make enough to pay a considerable taxes. You are not only a loser but a lying scumbag without a trace of basic human decency. You should stick to rightie blogs. The kind that push all the discredited lying sob stories. Besides modster I don't know who here respects a word you say or fails to despise you.

  1. On the "higher costs for rural communities" thing:

    This is real. I understand that it's a function of longer distances between hospitals, fewer clinics and health personnel, and that it's been that way for decades.

    One thing I'm curious about: A hard-core union organizer, whom I respect a lot, told me that if Colorado had really gotten the Federal exchanges, instead of opting into expanding Medicaid coverage through Colorado's exchange, that those rural costs would be coming down.

    Is he full of baloney, or what? I haven't come across anything like this in my reading on the ACA.

    1. Response from Bob Semro: I agree with your first statement, costs and premium rates in rural areas are tied to higher costs of living in some rural areas, limited hospitals and clinics, lack of provider competition, greater physician practice areas and a disproportionately older population.  And you are right, it has been that way for ever.
      I would like to hear more about your friend’s argument on the Medicaid and federal exchanges.  At face value, I don’t see the connection.  I’m not sure that opting into Medicaid via a federal exchange or a state exchange is fundamentally different or would impact enrollment significantly in either direction, especially in rural areas.  I would also wonder why Medicaid enrollment levels would have substantial impact on private-market insurance premiums or provider availability.  But perhaps your friend has some insights that I am unaware of.

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