Dear Democratic Candidates: Time to Play Offense on the ACA.

2019 OPEN ENROLLMENT ENDS (most states)

Time: D H M S

An Open Letter to Democratic U.S. Congressional Candidates:

As I've noted before (and as others, such as Greg Sargent of the Washington Post have confirmed), when it comes to the Affordable Care Act, the Republican Party has been reduced, at this point, to literally running against the word "Obamacare" instead of the actual law itself.

By this point in the 2014 campaign cycle, those of you with any sense have moved from running away from the Affordable Care Act to going on offense by not only defending the law but actively pointing out the benefits that it's bringing to your constituents (or at the very least actively countering bald-faced lies about it from your opponent).

However, for those of you who aren't doing so yet, you should be aware that your own House Energy & Commerce Committee caucus has thoughtfully posted a handy report breaking down ACA enrollments by every US Congressional District.

Let's take my own (fairly safe Democratic) district held by Sandy Levin as an example:

This fact sheet summarizes new data on the significant benefits of the health care reform law in Rep. Levin’s district. As a result of the law:

  • There are 25,000 district residents who were previously uninsured but now have quality, affordable health coverage because of the Affordable Care Act.
  • Overall, the number of uninsured district residents has declined by 27%.
  • Approximately 22,600 individuals purchased quality, affordable coverage through the new health insurance marketplace, 19,400 enrolled in Medicaid, and 5,400 young adults were able to retain coverage through their parents’ plans. For more than 87% of the individuals enrolled in the health insurance marketplace, financial assistance was available that could reduce the cost of the average plan to $97 per month.
  • 283,000 individuals in the district – including 52,000 children and 122,000 women – now have health insurance that covers preventive services without any co-pays, coinsurance, or deductible.
  • 10,400 seniors in the district received Medicare Part D prescription drug discounts worth $14.1 million.
  • 153,000 seniors in the district are now eligible for Medicare preventive services without paying any co-pays, coinsurance, or deductible.
  • 235,000 individuals in the district are protected by ACA provisions that prevent insurance companies from spending more than 20% of their premiums on profits and administrative overhead. Because of these protections, over 8,400 individuals in the district received approximately $3.4 million in insurance company rebates.
  • Up to 36,000 children in the district with preexisting health conditions can no longer be denied coverage by health insurers.
  • 235,000 individuals in the district now have insurance that cannot place annual or lifetime limits on their coverage.

Now, there are a couple of caveats on the numbers here:

  • First, this only includes private marketplace enrollment figures through April 19th and doesn't account for those who never paid their first month's premium (around 800,000 people). The good news is that, ironically, by my calculations this number should be more than cancelled out by the additional enrollees since April 19th (around 1.3 million nationally, of which around 900K have paid). Even if I'm off by a bit one one side or the other, there's a good 100K cushion there...so yes, the number of paid enrollments as of September should be around the same as the total number listed in your district report.
  • Second, the Medicaid numbers only include the 6.7 million newly-added enrollees through May 31st, which leaves out an additional 500,000 Medicaid/CHIP enrollees from June....as well as, I'd imagine, another good half million or more from July and August. Whatever "Medicaid/CHIP" number is listed in your district report is almost certainly at least 15% higher by now (for states which have expanded Medicaid) or perhaps 5% higher for states which didn't.
  • The only quibble I might have with these numbers is the first one, which assumes 60% were previously uninsured based on the KFF study instead of the actual 57%. However, again, those numbers are only based on either 4/19 or 5/31 totals, so I'm certain that the 3% difference has been more than made up by now, making those numbers accurate as of September.
  • The other slightly squirrelly number is the "young adults on their parents plan" figure, which has been the subject of dispute since it was released. Again, however, this number is from 2 years ago (remember, some ACA provisions have been in effect since 2010), and whatever the actual number was then has certainly gone up since that time.

In other words, no matter what, you should be on very safe ground with the numbers in these reports. Use them.

UPDATE: As Sargent noted in yesterday's Washington Post, concern over the ACA being repealed (or gutted, anyway) is one of the biggest motivators to make "dropoff Democrats" to get off their butts and into the voting booth:

Should the GOP take control of the Senate, drop-off voters are most concerned that “Republicans will take away a woman’s right to choose and restrict access to birth control” (58 percent rank this very concerning), “Republicans will cut access to health care for 8 million people and let insurance companies refuse to cover people with pre-existing conditions” (58 percent) and “Republicans will cut back workplace protections for women, denying equal pay for equal work” (57 percent)….

Of course, the truth is that it's far more than 8 million people whose healthcare is at risk here. There's also another 6-7 million or so on Medicaid who'd be at risk of having their coverage yanked away as well, not to mention that millions more would be at risk of going back to the "good old days" when insurance companies could kick you to the curb on a whim or tell you to go pound sand if you have a pre-existing condition (that is, something which requires, you know, medical treatment).

The Affordable Care Act (aka "Obamacare", aka "the ACA") isn't a perfect law; no law is. However, it's still a huge improvement over what we had before, and it paves the way for an even better system going forward. That's why I support it, and that's why Democrats should be doing so loud & clear this fall.