FACT SHEET: BUSTING THE GOP MYTHS: “Obamacare” Is Not Failing

From the House Democratic Leader's Press Office

January 18, 2017

BUSTING THE GOP MYTHS: 'OBAMACARE' IS NOT FAILING

GOP MYTH: On January 4, at a press conference, Speaker Ryan told http://www.speaker.gov/general/relief-obamacare-pence-joins-ryan-gop-leaders-press-conference Americans, "The law ['Obamacare'] is failing." The facts show that this claim is simply false.

THE FACTS: Overall, using every measuring stick, the Affordable Care Act is working. More specifically, the 2017 ACA Marketplaces are performing well.

2017 ACA Marketplaces Are Performing Well

* Enrollment In ACA Marketplaces for 2017 Is Higher Than At the Same Point Last Year. As of December 24, 2016, more than 11.5 million people nationwide were signed up for ACA Marketplace coverage, an increase of about 300,000 over last year. Nationwide demand for health coverage is higher than ever, as Americans prove once again that Marketplace coverage is vital. Open enrollment for 2017 in the ACA Marketplaces remains available until January 31, so this enrollment number will continue to climb. [CMS, 1/10/17] ((https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-01-10.html))

* According to Outside Nonpartisan Analysts, The ACA Marketplaces Are Stronger Than Ever in 2017. Analysts Are Calling the 2017 Average Rate Increase "A One-Time Pricing Correction." It is clear by all measures that there is no "death spiral." As CNN Money reported, "Obamacare is not in a death spiral. In fact, insurers' prospects in the individual market are looking brighter, according to a new S&P Global Ratings analysis.... S&P expects rate requests for 2018 will be 'well below' [2017 rate increases]."... Similarly, CBS News reported, "The S&P analysis concludes that the most recent premium hike was a 'one-time pricing correction' designed to fix a host of issues lingering from Obamacare's first few years, such as initial premiums that had been priced too low as well as the end of an ACA reinsurance program that aimed to keep prices down." For 2017, S&P estimated that "continued pricing correction... will result in closer to break-even results [for insurers], in aggregate, for the individual market, and more insurers reporting profits in this segment." [CNN Money, 12/27/16] ((http://money.cnn.com/2016/12/27/news/economy/obamacare-premiums/)) [CBS News, 12/28/16] ((http://www.cbsnews.com/news/is-obamacare-set-for-a-healthy-turnaround/))

Lower Rate of Growth in Health Insurance Premiums

* The Real Average Annual Growth Rate of Premiums Paid by Employees for Employer-Based Coverage Has Slowed Dramatically - from 7.2 Percent to 3.1 Percent - Since Enactment of the ACA. In claiming that the ACA is failing, Republicans always claim that the premiums paid by the vast majority of Americans have skyrocketed since enactment of the ACA. And yet the facts show that the opposite has occurred. 155 million Americans receive employer-based coverage - a strong majority of those under age 65. In the decade BEFORE the ACA, family premiums paid by employees, adjusted for inflation, were growing at an unsustainable average rate of 7.2 percent a year. Since 2010, that growth rate has been slashed to 3.1 percent. Indeed, overall, family premiums in employer-based coverage are $3,600 lower today than if growth had continued at pre-ACA rates. [CEA] ((https://www.whitehouse11.gov/sites/default/files/page/files/20161213cearecordhealhcarereformchartbook.pdf))

* The Headlines of 2017 Marketplace Premium Increases Do Not Reflect the Premiums Paid by Vast Majority of Marketplace Consumers; the Vast Majority Pay Low to Moderate Premiums. Roughly 85 percent of Marketplace consumers receive tax credits, which both make their coverage more affordable and also protect them from premium increases. (They are generally protected from premium increases because, under the ACA, consumers pay a set percentage of their income on premiums.) As a result, the vast majority of consumers in the Marketplaces pay low to moderate premiums. For example, in 2016, nearly 70 percent of consumers had the option of selecting a health plan with a premium, after tax credits, of less the $75 per month. Furthermore, the average premium, after tax credits, paid by Marketplace consumers in 2016 was $113 per month. [HHS] ((https://aspe.hhs.gov/sites/default/files/pdf/172176/2016HealthInsurance.pdf))

Greater Coverage

* Due to ACA, Uninsured Rate Now At A Record Low. Due to the ACA, the uninsured rate is now the lowest on record - 8.6 percent. Under the ACA, the uninsured rate has been slashed almost in half - from 16.3 percent in 2010 to 8.6 percent today. [CDC] ((https://www.cdc.gov/nCommittee on Homeland Security/data/nhis/earlyrelease/insur201609.pdf)) [HHS] ((https://aspe.hhs.gov/basic-report/overview-uninsured-united-states-summary-2011-current-population-survey))

* 20 Million Gaining Coverage. Overall, 20 million previously uninsured Americans have gained health insurance coverage since enactment of the Affordable Care Act. These 20 million have gained coverage both through the ACA's Medicaid expansion and through the ACA Marketplaces. [HHS ((http://www.hhs.gov/about/news/2016/03/03/20-million-people-have-gained-health-insurance-coverage-because-affordable-care-act-new-estimates)) ]

Numerous Consumer Protections

* No Discrimination Against Pre-Existing Conditions. The ACA prohibits insurers from denying coverage or charging a higher premium to someone with a pre-existing health condition, like asthma or heart disease. Current law protects up to 129 million Americans with a pre-existing condition. [HHS] ((https://www.hhs.gov/about/news/2016/12/13/new-report-details-impact-affordable-care-act.html))

* End to Annual and Lifetime Limits. Before the ACA, 105 million Americans, most of them with employer coverage, had a lifetime limit, or cap, on their insurance policy. When a serious illness struck, such coverage limits could force families into bankruptcy. The ACA prohibits annual and lifetime limits. [HHS] ((https://www.hhs.gov/about/news/2016/12/13/new-report-details-impact-affordable-care-act.html))

* Free Preventive Services in Private Health Plans. 137 million Americans with private insurance now benefit from the ACA provision that requires private health plans to cover preventive services - like flu shots, cancer screenings, contraception, and mammograms - with no co-pay or deductible. [HHS] ((https://www.hhs.gov/about/news/2016/12/13/new-report-details-impact-affordable-care-act.html))

* Coverage for Young Adults Up to Age 26 to Stay on Their Parents' Health Plan. An estimated 2.3 million young adults have benefited from the law allowing young adults to stay on their parents' health insurance up to age 26. [HHS] ((https://www.hhs.gov/about/news/2016/12/13/new-report-details-impact-affordable-care-act.html))

* Focus on Patients, Not Profits. Under the ACA, insurers must spend at least 80 percent of premiums on actual health care - as opposed to advertising, CEO pay, and profits; if they don't, they must send rebates to consumers. As a result, since 2012, consumers have received $2.4 billion in rebates. [CMS] ((https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/2014MedicalLossRatioReport.pdf))

Benefits for Older Americans

* A Stronger Medicare. Since the enactment of the ACA, the solvency of the Medicare Trust Fund has been extended by 11 years. Repealing the ACA would drastically shorten the Trust Fund's life. [CMS] ((https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-06-22.html))

* Lower Costs for Prescription Drugs. Nearly 12 million seniors have saved more than $26.8 billion on their prescription drug costs since 2010 - an average savings of more than $2,000 per senior. [CMS] ((https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-01-13.html))

* Free Preventive Services in Medicare. The ACA created a new Medicare benefit - a benefit providing coverage of key preventive services with no co-pay or deductible. 39.2 million seniors took advantage of at least one preventive service with no copays or deductibles in 2015. [CMS] ((https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-02-08.html))

* 55 to 64 year-olds Can Now Find Affordable Coverage: Before the ACA, many early retirees could not find affordable coverage. By eliminating discrimination against pre-existing conditions and limiting age rating to 3:1, the ACA has now ensured affordable coverage for many of those ages 55 to 64. [HHS] ((https://aspe.hhs.gov/sites/default/files/pdf/207946/ACAHistoricIncreaseCoverage.pdf))

Improved Quality

* A Significant Drop in Unnecessary Hospital Readmissions. As a result of the ACA, unnecessary hospital readmissions in Medicare have fallen for the first time on record, dropping 8 percent between 2010 and 2015. Cumulatively since 2010, Medicare enrollees have avoided 565,000 unnecessary hospital readmissions. [HHS] ((https://www.hhs.gov/about/news/2016/09/14/new-data-show-major-improvements-health-care-access-affordability-and-quality-under-affordable-care))

* 87,000 Lives Saved. 87,000 lives and nearly $20 billion have been saved, due to a 17 percent reduction in hospital-acquired conditions, such as infections, from 2010 to 2014, under the ACA. This comes as a result of the ACA's focus on incentives for improved care. [HHS] ((http://www.hhs.gov/about/news/2015/12/01/national-patient-safety-efforts-save-lives-and-costs.html))

* Strong Consumer Satisfaction with Health Insurance Plans in the Marketplaces. In 2016, in a survey, 82 percent of consumers in Marketplace plans or newly insured under Medicaid due to the ACA expressed satisfaction with their coverage. [Commonwealth Fund] ((http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2016/may/1879collinsamericansexperienceacamarketplacefebapril2016tb.pdf))