Examining Mitch McConnell’s Claims on Health Care Overhaul
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Version 0 of 1. The Senate majority leader, Mitch McConnell, Republican of Kentucky, made a vigorous and urgent argument this week to repeal and replace the Affordable Care Act. Speaking on the Senate floor Monday and Tuesday, he argued that drafting a replacement bill behind closed doors is not unusual, and discussed various criticisms of Obamacare. Here is an assessment. Referring to a recent report from the Department of Health and Human Services, Mr. McConnell claimed that “nearly two million Americans” opted out of public health care exchanges, “and the most common reason they cited for doing so was because it was too expensive.” In his statement, Mr. McConnell was referring to mostly people who picked a plan, but then never took the final step of paying a premium and enrolling — not people who left the exchanges after paying for insurance. Of the 12.2 million people who signed up for a plan by the end of open enrollment on January 31, according to the H.H.S. report, 10.3 million had actually paid for their coverage by February — a difference of 1.9 million. But in the past, H.H.S. has estimated the number of people who paid for coverage by March. It is unclear why the government has chosen to limit the data to February this year, but the methodological difference can be significant. Those who signed up for a health care plan in the last two weeks of January — 500,000 this year, by one estimate — did not actually have to pay until March. So it is premature to assume they all canceled their coverage. Mr. McConnell’s claim that the “most common reason” for cancellations was high cost is also exaggerated. In a separate report, the department surveyed about 4,000 people who canceled before paying a premium, 46 percent of whom cited cost as the reason. About 14 percent receive coverage elsewhere, according to an H.H.S. spokeswoman. The same report also surveyed 14,000 people who canceled coverage after paying at least a month’s premiums, 27 percent of whom said they canceled because of affordability. About 60 percent said they obtained insurance through their employer, and another 22 percent said they became eligible for Medicare. A May report from H.H.S. estimated that average exchange premiums in 2017 were 105 percent higher than average individual market premiums in 2013. That comparison, however, is imperfect, as H.H.S. itself acknowledges. First, the report looks only at the sticker price of premiums, discounting the fact that a vast majority of exchange enrollees receive a subsidy that helps blunt premium costs. Second, the plans and the insurance pools of 2013 are not the same as those of 2017. Some plans may have been cheaper in 2013, but covered so little that they would now fail to meet the Congressional Budget Office’s definition of insurance. Under the health care law, insurers can no longer deny coverage to people with pre-existing conditions. Predictably, more comprehensive plans that cover more and sicker people are costlier. And perhaps most importantly, the report compares two fundamentally different universes of plans: those in the entire individual market in 2013 and those only in the federal exchange in 2017. Mr. McConnell suggested Democrats repeatedly refused to cooperate with Republican “ideas on a better way forward.” His office did not respond to a request for clarification, but whether he is referring to legislation to repeal, roll back or amend the current health care law, he is incorrect. The Congressional Research Service recently cataloged legislative efforts to repeal, defund or delay the Affordable Care Act from 2011 to 2016. It listed 20 enacted bills that altered funding, some of which passed with overwhelming bipartisan support. Democratic leadership, and most of the caucus, have consistently rejected efforts to repeal the health care law. But even a few of the approximately 40 bills passed in the House that sought to undo parts or all of the Affordable Care Act garnered limited Democratic “yes” votes. A spokesman for Senator Chuck Schumer of New York, the Senate minority leader, gave several recent examples of Democrats’ requesting to be involved in the health care reform process. Responding to criticisms that Senate Republicans are drafting the health care bill behind closed doors, Mr. McConnell charged Democrats with procedural hypocrisy. Mr. McConnell, who repeatedly chastised Democrats for “going the partisan route” and for secrecy as the Affordable Care Act was being drafted, is right that part of the health care law was eventually passed through reconciliation — a tactic that allows Congress to push through legislation with a simple majority, rather than the 60 votes typically needed in the Senate. But selectively focusing on the last step of the current health care law’s history ignores months of debate that included more than 20 hearings, at least 100 hours of committee meetings and markups, more than 130 amendments considered and at least 79 roll-call votes. Mr. McConnell is also making misleading remarks about how reconciliation was used in the Affordable Care Act’s passage. Both the House and the Senate passed versions of the bill — by 243 to 173 and by 60 to 39 — before Democrats lost their 60th Senate vote and resorted to reconciliation. In contrast, Senate Republicans intend to overhaul health care through a reconciliation bill, bypassing the 60-vote threshold entirely. The process would still allow senators to debate on the floor for 20 hours and offer amendments, but that would be significantly less than the time spent discussing the Affordable Care Act. |