"Obamacare does not even address the issue of costs. In fact, it exacerbates the problem and causes 85 percent of Americans who had health insurance and who liked it extraordinary disruption. So, it's been a catastrophe for health care and for the economy at large." -- Sen. Mitch McConnell, R-Ky., interview on "On the Record with Greta van Susteren," Dec. 4, 2013
McConnell, the Republican leader, has long been a critic of the Affordable Care Act, also known as Obamacare. But his recent comments on Fox News appeared overheated: Are the 85 percent of Americans who have health insurance facing "extraordinary disruption?"
McConnell's comments in some ways are the flip side of President Barack Obama's claim earlier this year that "the 85 and 90 percent who already have health insurance" will not notice anything but better health care. He argued that impact will be felt instead by "that small group of people -- 10 to 15 percent of Americans; now, it's still 30 million Americans, but relatively a narrow group -- who don't have health insurance right now or are on the individual market and are paying exorbitant amounts for coverage that isn't that great."
Obama earned our criticism because he airily suggested that the 85 to 90 percent with health insurance already "don't have to worry about anything else." We found many examples that called that claim into question. But can a case be made that everyone with health insurance faces "extraordinary disruption?"
As McConnell noted, a vast majority of Americans already have health insurance, and many get it through their employers. The Census Bureau says that as of 2012, 64 percent of Americans have a private health plan, with 55 percent getting it through their employer. Another 33 percent get health care through a government plan such as Medicare and Medicaid, while about 10 percent buy their own plans. (The numbers add up to more than 100 percent because people can be covered by more than one type of insurance in a year.)
When the law is fully implemented by 2018, the Congressional Budget Office predicts, 7 million people will be dropped from employer-based plans and 5 million will shift out of private plans. The number of people in Medicaid will increase by 11 million people, while the number of uninsured will decrease by 25 million.
For the sake of argument, let's assume that everyone who has to move from employer and private plans faces "extraordinary disruption." That's 12 million people -- out of 226 million under of the age of 65 with some form of insurance. That amounts to just over 5 percent -- and McConnell was also including people on Medicare.
Still, as we have noted previously, one of the most negative assessments we have seen of the new law is that 129 million are at risk of losing their insurance. That would be about 68 percent of the private market. That estimate is based largely on the government's estimate of the number of plans that will lose their grandfathered status.
But for many workers, especially those at larger firms that self-insure their plans, a loss of grandfather status likely will not be noticed, experts say. Indeed, 94 percent of the workers in firms with more than 5,000 employers are in partially or fully self-funded plans.
Even if one assumes, evidence to the contrary, that all 68 percent would face "extraordinary disruption," that still amounts to just 37 percent of the people with insurance (68 percent of the 55 percent in employer-based plans.)
Both Obama and McConnell appeared to include Medicare, the program for retirees, in their figures, though the health care law is aimed mainly at people under the age of 65. Still, the law does affect Medicare and one can claim the impact is half-full (more benefits) or half-empty (cuts to providers and Medicare Advantage). Democrats tend to emphasize the former and Republicans the later.
Don Stewart, a spokesman for McConnell, pointed to a report that UnitedHealth Group has dropped thousands of doctors from its Medicare Advantage networks because of the law. About 27 percent of the Americans on Medicare belong to Medicare Advantage.
So, given that about 16 percent of the Americans with health insurance are on Medicare, let's assume one-quarter face "extraordinary disruption" because of Obamacare. That's another 5 percent of Americans currently with health insurance, if we are being generous.
Let's also assume all 10 percent of the people in the individual market face turmoil. What does that get us? A little over 50 percent of Americans -- and that's assuming worst-case scenarios. For instance, thus far there does not seem to be much impact on people on Medicaid (16 percent of Americans) or military health care (about 5 percent).
Stewart said McConnell "could have been more precise in that unscripted interview, but it's not clear to me that he's claiming every person in the 85 percent will each have disruption, but rather making a case that has been made consistently (despite the President's claim to the contrary) that people who already have insurance are facing disruption."
Stewart pointed to a number of news reports, such as employers cutting coverage for spouses, premium hikes, efforts to scale back high-end plans to avoid the "Cadillac tax," and concerns by union leaders that the law will drive up costs for their health care plans.
"We're not making the argument that you're trying to quantify," Stewart said. "We can all stipulate that everyone with existing insurance won't have 'enormous disruption,' but what is undeniable is that there was, is and will be enormous disruption among people with existing coverage."
Stewart described the 85 percent as "the universe of people who stand to have an effect as Obamacare attempts to help the 15 percent. He could have been more clear about that." But Stewart added: "Unlike the President, he didn't claim that every single one of them would have the same outcome (and I believe the President had that as a talking point, not as part of an answer in a standup interview). It's not a regular talking point for him; it is a regular idea."
We understand that things can get garbled during live television interviews. McConnell appears to be making an argument that Sen. Ted Cruz, R-Tex., made a few weeks back -- about how the efforts to help the uninsured have hurt the broader population who already have insurance. Cruz's numbers, however, did not add up at all.
McConnell did not make that same mistake, but he still suggested that a large percentage of Americans with insurance (85 percent) will face extraordinary disruptions in their health plan. It's really much too early to be able to make that judgment, especially given that most Americans are in employer-provided plans.
(We will leave aside McConnell's comment that the law exacerbates costs, except to note that the jury is still out on that. The White House maintains that the health care law has helped on costs.)
The Obama administration has erred in playing down the impact on Americans of this far-reaching law, while the law's opponents run the risk of over-exaggerating the potential impact. As we have repeatedly noted, there are winners and losers, and no one really knows what the final score will be.