The left has been very successful with the Affordable Care Act, not as policy, but as a political boogeyman: Republicans, they claim, desire to take away health coverage from millions of Americans. To support this claim, Democrats have managed to turn their talking points about the law into widely accepted conventional wisdom. Anyone who challenges a handful of points now — primarily about pre-existing conditions — is immediately and laughably dismissed, even if the challenge is fair.
It’s no wonder then that a survey about the law’s impact reveals how deeply and widely the left’s retelling of history has spread. Even independent women (not registered Democrats!) regurgitated demonstrably false “facts” about the law when asked about the number of people with pre-existing conditions, insurance options for people with pre-existing conditions, and the law’s Medicaid expansion. Here are a few of the most prevalent myths:
How Many Americans with Pre-Existing Conditions Faced Barriers to Coverage Before the ACA?
To justify sweeping changes to insurance markets, including new taxes, subsidies, regulations and restrictions, the left has intentionally perverted an insurance term of art — “pre-existing condition” — to suggest that it applies to any person with any type of ongoing medical issue.
So now, many people believe that 129 million Americans with pre-existing conditions faced barriers to coverage before the law passed (and therefore stand to lose coverage now if the law is undone)? Seventeen percent of independent women in our survey answered “129 million Americans” when asked about this figure, making it the most popular answer after “I don’t know” at 67 percent.
Where did they get that? The oft-repeated figure originated with the Obama Administration, but many have used it: During the 2017 debate about repealing and replacing the ACA with a Republican alternative, none other than Sen. Kamala Harris earned four pinocchios from the Washington Post fact checker for using the misleading “129 million figure.”
The high number, which represents about 40 percent of all Americans, may tell us something about how many people face chronic health conditions. But it doesn’t tell us about how many people with chronic conditions benefited from the Affordable Care Act. It doesn’t tell us the key metric of how many people could not get insurance due to a pre-existing condition, which quite literally means a health condition that existed before one sought insurance coverage for it.
One reason that the vast majority of Americans with health conditions do not truly have pre-existing conditions (that would prevent them from accessing health coverage) is that most Americans are covered through an employer-sponsored health plan, Medicare, or Medicaid. These forms of insurance did not deny coverage based on health status before the ACA, nor would they do so now in the absence of the law.
Still, the damage has been done and many Americans refuse to believe that the impact of the ACA’s rules on pre-existing conditions have benefitted so few of our compatriots. Only 2.3 percent of respondents chose the right answer, that approximately 500,000 people faced barriers to coverage before the ACA.
What Will Happen to People with Pre-Existing Conditions if the ACA is Overturned?
Similarly, we found that many people misunderstand the legal challenge to the ACA that is currently before the Supreme Court and its implications. More women in our survey believed that people with pre-existing conditions would immediately lose insurance coverage (41 percent) than not (32 percent).
The lawsuit — California v. Texas — focuses on the individual mandate to purchase insurance and the tax penalty associated with it, which was changed to $0, but still left in the law. In reality, there are three possible outcomes: The court could uphold the law, strike down just the mandate and its penalty, or strike down the whole law. However, even in this last scenario — which, especially given comments from the Justices at the oral argument of the case November 10, is the most unlikely outcome — the court would “stay” or pause its decision for some time, giving Congress a chance to revisit the law. Lawmakers have already prepared legislation for this possibility to keep protections for pre-existing conditions in place.
How Do Health Outcomes for Medicaid Compare to the Uninsured?
We see in the media that the ACA is often portrayed as a huge expansion of health coverage. But most of the ACA’s coverage expansion was not due to the law’s rules on pre-existing conditions. In fact, none of the law’s changes to private insurance regulation or subsidization had as great an impact on the number of newly covered Americans as the law’s Medicaid expansion, where about 75 percent of the newly insured got covered.
The Medicaid expansion is most often justified as a compassionate policy to help low-income residents of participating states who did not previously qualify for the program. Perhaps that’s why a majority of survey respondents (50.7 percent) answered that health outcomes in Medicaid are better than for the uninsured.
Only 21.7 percent of respondents answered correctly that, sadly, while Medicaid puts pressure on government budgets and crowds out private insurance (and enriches hospitals), Medicaid fails to result in better health outcomes. Those with Medicaid are no better off than those who are uninsured. A study from Oregon showed that those added to the Medicaid program during expansion saw “no significant effect” on their health compared to being uninsured. This study sits on top of a pile of research that for years has documented Medicaid’s relatively poor outcomes and poor access to healthcare services. Yet it seems many ACA advocates are happy to check the box of taking care of poor (or moderately poor) people by herding them into an ineffective and costly government program that doesn’t really improve their health.
All Americans should be interested in setting the record straight about the impact of the law. Even its champions should welcome a fair fight, free of linguistic distortions, misused data, and misleading fear-mongering about legal and policy issues.
But sadly, now that the election results indicate a likely Biden-Harris Administration, the bully pulpit of the presidency will return to the team who originally advanced the narrative behind the Affordable Care Act, and who will continue to twist facts in order to double down in the same direction.
Savvy consumers of information should learn how to spot this political sleight of hand, but reversing a decade of misinformation is hard to do. In order to learn what is right about health policy, many Americans first have to unlearn what is oft-repeated but ultimately, untrue.