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| Speaker Boehner's tweet |
Boehner's tweet derives its conclusion from a GOP requested study from the Office of the Actuary, Centers for Medicare and Medicaid Services, which was released last Friday, the 21st of February.
The first thing that I should mention is that the population of people considered by the study is individuals who receive their health insurance through their small business employer and not through the ACA state health insurance exchanges. So this is not about ObamaCare causing people financial harm even though Boehner interpreted it that way.
When the Affordable Care Act was created, it added requirements known as sections 2701, 2702 and 2703 to the Public Health Services Act. These sections are intended to end discrimination by insurers on the patient population.
Section 2701 is titled "Fair Health Insurance Premium" and changes a practice called "community rating" where insurance companies used to be able to discriminate by charging higher prices for women of child bearing age; those having more health claims; or the elderly. Now premium prices can only vary between individuals because of individual versus family enrollment; geographic area; age (but the ratio of higher premiums for the elderly is reduced from 5:1 down to 3:1); and tobacco use.
Section 2702 requires insurers to accept all applicants and is designed to prevent insurance company discrimination due to pre-existing conditions.
Section 2703 requires that group and individual health insurance must be renewable.
So, Boehner's tweet is actually attacking that part of the ACA that protects consumers from discrimination, probably because he didn't read it or perhaps because he didn't understand it. The obvious fact is that he just read the lines in the study that supported his unreasonable view that "ObamaCare is bad" and tweeted. This is unfortunate because there are important aspects of the study that place their own conclusions into serious doubt. Some of this is self revealed, such as the admission that there are other studies that have found insignificant change in premiums. Also, some parts of the study text indicate that the results are highly suspect and subject to large variations.
The study also found that the employer sponsored health insurance premium price changes would only affect small employers (100 employees or less) and the premium changes would only come from section 2701 requirements. This is because they speculate that smaller and younger companies have younger employees who have been able to take advantage of the greater old to young ratio in premium prices allowed before ObamaCare and section 2701 requirements. This would make those employers (only if they provide insurance for their employees) more likely to have increased premium prices after January 1, 2014. The study also only speculates that any increase in the employers insurance costs would be passed on to their employees.
Additionally, these new requirements are only effective for employer health policies that are not grandfathered. Grandfathered policies are any that existed on or before March 23, 2010. So only new small businesses who provide employer sponsored health insurance and were created after March 23, 2010 should have been considered in the study.
However, the study indicates that 17 million individuals would be in this population. This can be shown to be inaccurate by using the Business Dynamics Statistics data from the census.gov website. One can see there that the maximum number of employees in new small businesses, using the largest employee population cited in a range for the category of small business created through all of 2010 and 2011 is about 2.3 million each year. This calculates to 4.6 million employees. Estimating a 20% increase year over year through 2013 adds another 6.2 million employees for a total population of 10.8 million. This is a very high estimate since it would mean that nearly all of the increase in employment in the USA since 2010 has been from small business. Prior government estimates of jobs created by small business is closer to 45% of the total. A more reasonable population would be 5 million affected. Still not a small number, but much smaller than the estimate of 17 million cited in the study. (Even less than GOP led states have refused to provide expanded medicaid for.)
The study also speculates that about 35% of the population would receive reductions from their pre-ACA insurance premium costs. The other 65% would receive increases that would put their 2014 premiums at about the average cost for health insurance prior to the ACA.
Additionally, the number affected is further trimmed down by the number of individuals who purchase health insurance from the ACA exchanges in their state. The benefit is that many who earn less than 400% of the federal poverty level will receive federal tax reductions. Hopefully, many of those people will take advantage of that and stop listening to misleading GOP rhetoric instructing them to avoid buying from the insurance exchanges.
Further the study stipulates that small businesses who currently provide health insurance may find it more advantageous for themselves and their employees to discontinue providing insurance and telling their employees to get their health insurance from the ACA state exchanges. Again, Republican deception has made a large portion of America uncomfortable with ObamaCare, so it is not clear that employees would readily accept this idea.
The small business employer also has the option to utilize the small business health insurance exchange established by ObamaCare. This option would allow the employer to continue providing insurance to its employees and be exempt from the section 2701 requirements.
Another option for the small business employer would be to self insure. This would also allow them to provide insurance to their employees and be exempt from the section 2701 requirements.
The total number of employees affected by minor premium increases is likely to be less than 3 million and even that number depends on a lot of the variables mentioned which could make the number much smaller. My suggestion for small business employees is to get your health insurance from the state exchanges.
Ultimately, if our Republican leaders would stop spreading misinformation and start to support ObamaCare, more people would benefit. The federal government can be a valuable partner to business and individuals despite what radical GOP-ers want you to believe.
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