Can Alarmist Propaganda Derail Insure Tennessee?

On the eve of the Tennessee legislature’s special session on Medicaid expansion, The Wall Street Journal over the weekend gave the Beacon Center of Tennessee an opportunity to expand its alarmist anti-Insure-Tennessee propaganda to a national audience. In a piece coauthored with Christie Herrera of the Foundation for Government Accountability (another libertarian think rant tank), Beacon CEO Justin Owen characterized Gov. Haslam’s plan as a “bad deal for the public” that will “hurt the neediest patients,” is financed with a “sketchy” funding scheme, and will bloat the national debt. Owen and Herrera summed up the coming week’s doings in melodramatic terms:

Tennessee lawmakers must decide if they are going to burden more state residents—and American taxpayers—with ObamaCare’s broken promises, failed schemes and unsustainable policies, or whether their state will lead the march toward more freedom, greater access, and better health outcomes.

Obamacare is, to be sure, complicated and a work in progress. But “broken promises, failed schemes and unsustainable policies” seems like a pretty harsh verdict (and by “harsh” I mean “delusional”) for a set of policies that can be demonstratably associated with…

…increased access to health insurance: In the one year period from Sept. 2013 to Sept. 2014, the uninsurance rate (percentage of adults lacking health insurance) dropped by 30% nationally. The drop is 36% in states doing the Medicaid expansion thing, 24% in those not. (Source: Urban Institute Health Policy Center.)

…a drop in growth of systemic health spending: Health inflation measured as a growth in national health expenditures in 2013 was at its lowest level since the statistic originated in the 1980s. (Source: Centers for Medicare and Medicaid Services.) Brookings sums it up this way: “Growth in health spending over the past four years has been the slowest rate on record in approximately 50 years.”

…the same or lower cost for most people in the individual market: For those with individual policies who had to change insurance because their old plans didn’t comply with minimum standards set by Obamacare or otherwise went away, 46% end up paying less, 39% more, and 15% the same. (Source: Kaiser Family Foundation.)

…some wins in quality of care: Obamacare changes to payment systems intended to stimulate cost savings were designed in part to improve outcomes as well, and there’s evidence that hospital-acquired infections and hospital readmission rates are significantly down. (Source: Dept. of Health and Human Services.)

…high levels of satisfaction: Survey data show that 78% of adults added to the ranks of those covered in 2014 are satisfied with their new health insurance. Also, 58% of those who have gained access to health care (either through exchanges or Medicaid expansion) say they are better off than before&#8212a number that rises to 70% for those who have actually used their coverage in some way. (Source: The Commonwealth Fund)

It is true, as Obamacare critics contend, that the expansion of coverage puts strains on the system. Many in the individual market may have narrower provider networks than before, and expanded Medicaid isn’t all that expanded if docs won’t take new Medicaid patients. These issues can add up to legitimate questions about whether increased access to insurance translates into increased access to care. A fair-minded person can also question whether some of the favorable trends and outcomes are merely coincident with Obamacare rather than caused by it. Odds are it’s some of both.

But to try to take down Insure Tennessee by tarring Obamacare as a package of “broken promises, failed schemes and unsustainable policies” is to live in a world of policy hallucination. If more people insured at lower cost with high satisfaction and some gains in quality translates into “failed schemes” then color me pro-failure.

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.