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What Was the Role of ObamaCare Premium Hikes in Trump’s Win?

As I noted in my piece assessing the claims that the two letters Jim Comey wrote on the Hillary email investigation cost Hillary the election, the correlation between the October 28 Comey letter and what Trump’s camp reports as a surge is not exact. According to them (and they seem to have seen in real time far more clearly than the Hillary camp), the surge started before the letter.

Trump’s analysts had detected this upsurge in the electorate even beforeFBI Director James Comey delivered his Oct. 28 letter to Congress announcing that he was reopening his investigation into Clinton’s e-mails. But the news of the investigation accelerated the shift of a largely hidden rural mass of voters toward Trump.

So something else (which I posited could be nothing more than Gary Johnson voters deciding to vote Trump) has to have happened as well.

In comments, rollotomasi offered another suggestion, one I think may be significant: ObamaCare premium increases.

The press started reporting that increases would happen before they were announced. To prepare for that, on October 20, Obama, in what was treated by some as a campaign stop in Miami but what was technically a policy speech on the increases, had this to say (after having delivered a long explanation that ObamaCare was working just as planned).

Now, the second issue has to do with the marketplaces.  Although the marketplaces are working well in most of the states, there are some states where there’s still not enough competition between insurers.  So if you only have one insurer, they may decide we’re going to jack up rates because we can, because nobody else is offering a better price.

In those states where the governor or legislature is hostile to the ACA, it makes it harder to enroll people because the state is not actively participating in outreach.  And so, as a consequence, in those states enrollment in the plan — especially enrollment of young people — has lagged.

And what that means is that the insurance pool is smaller and it gets a higher percentage of older and sicker people who are signing up — because if you’re sick or you’re old, you’re more likely to say, well, I’m going to sign up, no matter what, because I know I’m going to need it; if you’re young and healthy like you guys, you say, eh, I’m fine, life is good — so you have more older and sicker people signing up, fewer younger and healthier people signing up, and that drives rates up, because the people who use health care most end up being in the insurance pool; people who use it least are not.

And then, in some cases, insurers just set their prices too low at the outset because they didn’t know what the insurance pool was going to look like, and then they started losing money.  And so now they’ve decided to significantly increase premiums in some states.

Now, it’s these premium increases in some of the states in the marketplace that sometimes attracts negative headlines.  Remember, these premium increases won’t impact most of the people who are buying insurance through the marketplace, because even when premiums go up, the tax credits go up to offset the increases.  So people who qualify for tax credits, they may not even notice their premiums went up because the tax credit is covered.

And keep in mind that these premium increases that some of you may have read about have no effect at all if you’re getting health insurance on the job, or through Medicaid or Medicare.  So for the 80 [percent]-plus people who already had health insurance, if your premium is going up, it’s not because of Obamacare.  It’s because of your employer or your insurer — even though sometimes they try to blame Obamacare for why the rates go up.  It’s not because of any policy of the Affordable Care Act that the rates are going up.

But if you are one of the people who doesn’t get health care on the job, doesn’t qualify for Medicaid, doesn’t qualify for Medicare — doesn’t qualify for a tax credit to help you buy insurance,  because maybe you made just a little bit too much money under the law — these premium increases do make insurance less affordable.  And in some states, the premium increases are manageable.  Some are 2 percent or 8 percent, some 20 percent.  But we know there are some states that may see premiums go up by 50 percent or more.

One of the problems with ObamaCare is its complexity. If it takes 7 paragraphs to try to make a big rate hike sound better, it’s not going to work.

The actual rates for ObamaCare plan increases — with an average increase of 22% — came out October 24. There was a great deal of chatter between then and the election, especially around the November 1 start of sign-ups, as the Administration scrambled to get users to shop for a more affordable plan. Significantly, PA was one of the worst affected states.

According to a Kaiser Family Foundation, the ObamaCare hikes should not have mattered. It released a poll showing even among Republican voters, just 5% thought heath insurance was the most important issue. Except the poll, which was released on October 27, right in the middle of the discussion about spiking rates, was actually conducted from October 12 to 18, before the rate increases were announced (which to my mind makes it a largely useless but politically timed poll release). Moreover, the poll sampled far more self-identified Democrats than self-identified Republicans (408 to 285), meaning the margins of error would be far higher for Trump-leaning voters.

But in polls of voters taken after the election, repealing ObamaCare was the top priority among Republicans. 74% of those polled wanted to repeal ObamaCare, versus 30% who wanted to build Trump’s wall.

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Admittedly, this isn’t a good measure of the importance of premium hikes (though it does seem somewhat inconsistent with the Kaiser poll). It may be a measure of 7 years of relentless opposition to ObamaCare, compounded by Trump’s repeated description of the program as a disaster.

Moreover, while the October 24 premium hike may explain why Trump started surging before the Comey letter, it wouldn’t explain what Hillary’s camp describes as energizing of Trump’s base when the second letter revealed nothing had been in the emails after all.

All that said, the premium hikes were probably the most significant policy discussion that happened between the last debate and the election. And for the small segment of the electorate that actually uses the exchanges, that policy change may have been felt very viscerally as they started the tedious process of shopping for an affordable plan.

Marcy has been blogging full time since 2007. She’s known for her live-blogging of the Scooter Libby trial, her discovery of the number of times Khalid Sheikh Mohammed was waterboarded, and generally for her weedy analysis of document dumps.

Marcy Wheeler is an independent journalist writing about national security and civil liberties. She writes as emptywheel at her eponymous blog, publishes at outlets including the Guardian, Salon, and the Progressive, and appears frequently on television and radio. She is the author of Anatomy of Deceit, a primer on the CIA leak investigation, and liveblogged the Scooter Libby trial.

Marcy has a PhD from the University of Michigan, where she researched the “feuilleton,” a short conversational newspaper form that has proven important in times of heightened censorship. Before and after her time in academics, Marcy provided documentation consulting for corporations in the auto, tech, and energy industries. She lives with her spouse and dog in Grand Rapids, MI.

11 replies
  1. G says:

    With all the blistering attacks against HRC, Trump had more loyal voting  blocs than Hillary: Altright, white supremacists, evangelicals, Republicans, the South.

    Clinton didn’t have any loyal voter blocs except maybe black women and voters in coastal areas.

     

  2. bevin says:

    There is something almost touching about Obama’s faith in the ‘marketplace’ and capitalism. It is obviously a religious thing with him, something which reason, experience, practice cannot scar or dent. Underneath all the politicking and special pleading, the years of back pedaling and genuflections towards power, the image emerges of a true believer, albeit in a system which has become the distillation of evil.

    I don’t doubt that people find Obamacare unsatisfactory. I do too, because it is part of an international campaign to commercialise health care and replace the single payer systems with similar insurance for profit scams.  Either Obama(Romney) care is replaced by Medicare for all or the NHS in Britain and OHIP in Ontario will be replaced by something much more costly, crueler and less effective.

    • John Casper says:

      bevin,

      Other than, “Learned a lot again from ew.” I don’t have much to say about the post.

      You don’t either.

      How do you remove the laws of supply and demand from health care supply chains?

      Can we do that with breathable air, potable, drinkable fresh water, safe food, sustainable energy, some metals, and minerals?

      Single payer socializes the insurance half of the equation. The suppliers–physicians–almost all owned by private equity groups–hospitals, nurses, allied health professionals, medical device makers, and Big Pharma–still compete.

      Why do you ignore the lack of quality control incentives in Medicare-for-all?

      Medicare-for-all catastrophic issues makes sense.

      For all other adult coverage, the federal government can incentivize quality control with an annual check to every adult for $5,000. The first $1,000 is “use it or lose it.” Adults have to spend that on check-ups, stuff that prevents or identifies more serious issues. The less they use of the remaining $4,000, they have to engage in behavior that encourages health, the more of it they keep.

      http://moslereconomics.com/2009/03/02/mosler-health-care-proposal/

      Democratic capitalism is the macro-economic “distillation” of the Hebrew scriptures–Old Testament–the Koran, and the New Testament. Take care of the poor, be fair.

      Obama supports that?

      Trump supports that?

      Does Trump not have “faith in the ‘marketplace’ and capitalism?”

      I’m glad you get that Obama’s a pro-choice Republican. Why don’t you ever criticize other Republicans?

      Mosler wants to include dental in the $5,000. Do you agree?

  3. bloopie2 says:

    How high were the Obamacare premiums to start with? If they were too low, then they are rising to an appropriate level. If you had told me, when I was paying $4 for a gallon of heating oil a couple years back, that heating oil prices were going up 20%, I would have screamed. Now, when I am paying under $2 for a gallon, a 20% increase doesn’t sound so bad. So, how many people who got Obamacare originally are now being shut out by the rate increases, being put into a position where they are back where they were before, with no health insurance? That–that–is the appropriate metric.

  4. bloopie2 says:

    By the way, I could barely sleep the other night because I had read this a little before bedtime:  “Paul Ryan says that the privatization of Medicare is going forward.”  Fuck, fuck, fuck.

  5. bloopie2 says:

    “Paul Ryan says there will not be mass deportations”. There you have it, folks, the Speaker of the House has just confirmed that President-elect Trump is a liar, and lied to us to get elected.”

    Wonder if that last sentence will show up on Fox News, or even on MSNBC? Are they all too cowardly to say that?

    • John Casper says:

      Thanks.

      Missed it.

      Per my reply to bevin, the Private Equity Groups own virtually all physician practices. Richard Gere’s character in “Pretty Woman” was the head of a private equity group.

      “So will primary care be nirvana for PE firms? Or just another fracking boom? Dr. Gorback, who doesn’t have a crystal ball either but knows a thing or two about doctors, mused:

      ‘Managing doctors is like herding cats. These deals almost always lead to a culture clash between the spreadsheet people and the doctors, resulting in disillusionment on both sides and parting of ways, usually with a lot of bitterness.
      The PE strategy of slash and burn is particularly unsuitable for this type of arrangement. I can see the PE guys acquiring practices with magic beans, loading up the company with debt, taking it to IPO, and burning whoever touches it.’

      That’s what happened to the intrepid souls who bought the PE firms’ prior hot product, the energy IPOs in 2013 and 2014.”
      http://www.nakedcapitalism.com/2015/07/wolf-richter-private-equity-scrambles-to-buy-primary-care-doctors-leverage-their-patients.html

      There may be examples of private equity groups who added value, but I don’t know of it. They borrow to buy–or own a controlling interest in–healthy companies. They put up very little of their own money. They load that debt onto the company. Then they pay themselves huge bonuses. Then, it gets worse. By the time the company has to file for bankruptcy, they are long gone.

      They control all the main-stream-media.

  6. Bitter Angry Drunk says:

    Anecdotal, but for what it’s worth, I enrolled in this state’s med program for the poor. Before I could even attempt to see anyone, I get a letter saying I’ll be dropped if I don’t provide more information that was never specified nor requested in the first place. So I call to see what’s going on, and was told to ignore it. “It’s Obamacare” was literally what I was told. Of course I was dropped.

    ACA was a massive giveaway to the insurance industry, and if it’s helped anyone (and I’m happy if people who need it have gotten help), it’s only so these instances can be highlighted as success stories. (“See? It’s working.”) But if it’s working in some states, it’s a complete joke in others… and a massive giveaway to the insurance industry. Which the insurance companies don’t even seem to want anymore.

    Did I vote for Trump? Fuck no. Did I vote for Hillary? The same.

  7. John Casper says:

    “ACA was a massive giveaway to the insurance industry,…”

    Yep.

    Without a public option, the health care oligopoly–Blue Cross Blue Shield and their for-profit arm, Well Point; Cigna, United, Humana, ….–fattened their profit margins by using the IRS to compel Americans to buy their l-o-u-s-y coverage.

    Using the IRS socialized their sales costs onto the taxpayers.

  8. lefty665 says:

    Think you’re on to something Marcy. The timing seems right, it’s a pocketbook shock to people who have not been thriving, and a visceral rubbing of noses in always getting the short end of the stick. With Hillary running for Obama’s third term on the theory that everything’s just hunky dory a lot of folks may have been ripe to say “The hell with that, we’ve been screwed again ” and extended a middle finger in the voting booth that was very conveniently at hand.

    From looking at the voting statistics it seems that while white guys looking for a big daddy and the Comey effect are real, as are some other pernicious factions, that even in aggregate they are marginal. Something else tilted the playing field. Increasing costs for health care that people are required to buy, and their hit to the pocketbook demonstration that real people don’t get a fair shake, seem likely as the major mover.

    I have not seen any documentation that the second Comey letter fired up Trump supporters as the Clinton folks are claiming. Is it out there, and if so would you be kind enough to provide a link?

    The quote you provided from the Trump data staff on re-weighting their polling suggests something else in play too.  It seems likely the polling reporting that showed Hillary up so far came largely from weighting collected data for things like probable voters, not from raw sampling errors, they were statistical adjustments. That means that Hillary’s leads were never as big as reported, so the changes near election day were not as large as reported.  Nate Silver was also re-weighting at 538 towards the end. He narrowed Hillary’s reported polling leads dramatically and pissed people off. Turns out he didn’t correct quite far enough.

    A small actual change that changes the outcome from Hillary to Trump is a big deal but would not be so startling had the reporting been suggesting a very tight race and not a better than 90% chance Hillary would win an election with unprecedentedly high emotions.

    It’s also curious that this is the second election in a row where the losing campaign was convinced it was winning. Think that means we’ve let too many statisticians with political agendas into the mechanics of polling.

  9. rugger9 says:

    It’s similar to the stuff the oil companies would do to gouge just before elections or Tom Ridge raising threat levels.  I also recall more than a few “Obamacare raised my rates” stories being exposed as apples-to-oranges comparisons.  Bottom line, O-Care not only created the exchanges, but also forced policies to have certain basic care items without ridiculous deductibles as well as the removal of pre-existing conditions as a cause for recission.  What existed before then were junk policies with high deductibles and low lifetime / annual payouts, kind of like cut-rate auto insurance, which were of course cheaper to buy.  Just don’t get sick.  So, this time AHIP got together to collude on rate increases to either scare the rubes into voting against O-Care (these increases had no economic basis other than greed), or they’d force them through by eliminating other options.  Win-win.

    That’s why a public option, or Medicare for all is needed, since that is the ONE thing currently separating us from the rest of the G-50, the cost of basic health care being shoved onto businesses and their employees.  AHIP will not go down without a fight, even though they do nothing that is value-added (and were the original and only “death panels”).

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