The GOP’s new case against ObamaCare

Republicans are shifting their line of attack on ObamaCare, abandoning assertions that few people are taking advantage of the law for new arguments that enrollees are getting stuck with low-quality insurance plans.

Republicans initially argued the Affordable Care Act (ACA) had not made a dent in the size of the uninsured population. Speaker John BoehnerJohn BoehnerRepublican Study Committee elders back Harris for chairman Dems to GOP: Help us fix ObamaCare The disorderly order of presidential succession MORE (R-Ohio) said in March 2014 that the law had led to “a net loss of people with health insurance” because of canceled plans. 

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That same month, Wyoming Sen. John BarrassoJohn BarrassoGOP pressures Kerry on Russia's use of Iranian airbase Tribes open new front in fight over pipelines Pipeline delay stirs anger, but not yet action, on Capitol Hill MORE, a leading Republican voice on healthcare, dismissed the administration’s announcement that 6 million people had signed up. “I don’t think it means anything,” he told Fox News. “They are cooking the books on this.”

A year later, the Obama administration is touting an estimate, based on Gallup polling data, that 16 million people have gained insurance under the law. The uninsured rate has fallen from 17 percent to 12 percent since the law took full effect at the start of 2014, according to Gallup.

Republicans are now acknowledging that an expansion has taken place, but are pointing to the quality of the insurance that people are gaining to argue that the law is still bad for the country. 

Asked Sunday about his previous statement, BoehnerJohn BoehnerRepublican Study Committee elders back Harris for chairman Dems to GOP: Help us fix ObamaCare The disorderly order of presidential succession MORE said on NBC’s “Meet the Press”: “Yeah, you know why there’s more people insured? Because a lot more people are on Medicaid.

“Giving people Medicaid insurance is almost like giving them nothing, because you can’t find a doctor that will see Medicaid patients,” Boehner added. “And so where do they end up? The same place they used to end up, in the emergency room.”

Speaking on the Senate floor last week, Barrasso did not mention the number of people who have signed up; he instead focused on the caliber of the coverage, saying, “there is a difference between coverage and care.”

He pointed to narrow provider networks under ObamaCare plans as limiting people’s access to care. 

“It’s a fact that there are people who now have coverage and can’t have access to care,” he said. 

Matt Mackowiak, a Republican strategist, said it is hard to counter Democrats pointing to the enrollment numbers.

“There aren’t that many good arguments to that number,” he said. “The only good argument I can think of is the Medicaid argument: that a pretty good percentage of that is from Medi-caid.”

But he said the point is that the law has caused other problems, has failed to bend the cost curve and has led to canceled plans. 

“No one doubted that ObamaCare was going to cover new people,” he said. “It was a question of what was it going to do to the system.”

The level of quality found under Medicaid coverage has long been the subject of debate. A 2014 study in the Journal of the American Medical Association found that Medicaid patients had a harder time finding a doctor’s appointment than privately insured people, a problem sometimes attributed to lower payment rates for doctors under Medicaid. 

Still, data from the National Health Interview Survey show that Medicaid patients see a doctor about twice as often as uninsured people. 

“On most measures, people with Medicaid fare about as well as people with private insurance, particularly with access to basic services,” said Rachel Garfield, senior researcher at the Kaiser Family Foundation, which does nonpartisan health policy analysis. “Where Medicaid has had some challenges is in access to specialty care.”

Republicans have also pointed to a survey released this week showing that most emergency room doctors have seen an increase in patients, despite the law’s intention to reduce the need for people to rely on emergency rooms for care. 

As for private insurance under the law, a Commonwealth Fund study released Tuesday notes that about half of plans offered through ACA marketplaces had narrow networks that limit choices of doctors. While the study notes that this type of plan also existed before ObamaCare, it says the law could be encouraging private insurers to keep costs down. 

Sara Collins, a vice president at the Commonwealth Fund, pointed to its survey results showing 78 percent of people are satisfied with their plans under ObamaCare. 

The debate over how many people are gaining insurance in the first place also has twists to come, said Joe Antos, a health policy scholar at the conservative American Enterprise Institute. 

Sign-ups went from around 7 million in 2014 to around 11 million in 2015, which he said did not bode well for future growth in the law. 

“If you only got 4 million in 2015, the odds of getting much more than an additional 4 million next year are extremely low, essentially zero,” he said. “It’s going to stabilize at a much lower pickup rate.”