Before Obamacare launched, conservative outlets warned that the law would collapse as insurers shunned the overpriced, overregulated insurance exchanges. "More Insurers Drop Out Of Exchanges," warned Fox Business. "Three Major Insurers Flee California's Obamacare Exchange," said HotAir.com. "The President's health care law has almost completely failed to increase insurance market competition," wrote the Heritage Foundation.
It continued after the law's launch. I remember, a month or two after HealthCare.gov opened (and crashed), being on a panel with a conservative writer who said that Obamacare might well enter a death spiral as insurers pull out of the marketplaces.
On Tuesday, the idea that insurers would flee Obamacare joined the long procession of Obamacare disasters that simply didn't happen. Health and Human Services Secretary Sylvia Matthews Burwell announced that in the 44 states where numbers were available, the number of companies offering plans in 2015 would increase by 25 percent. So, far from fleeing the exchanges, insurers are rushing into them. Competition is increasing.
This news is not, as I write this on Tuesday evening, being carried on the home pages of Fox Business, HotAir.com, or the Heritage Foundation. (In case you're wondering, the most recent Obamacare article on FoxBusiness.com is "Obamacare website still not secure?"; on Hot Air.com, it's "How many people are poised to lose 2014 Obamacare coverage?"; at Heritage, it's "Why you can't keep your plan under Obamacare, explained in 3 minutes.")
This is the problem in the debate about Obamacare. The two sides live in different informational universes. A few days ago, the New Republic's Danny Vinik tweeted a picture of the headlines he was receiving from the conservative YG Network:
That top headline, "More bad news for Obamacare exchange customers," quotes a New York Times report that "in many places premiums are going up by double-digit percentages within many of the most popular plans." It omits the next two sentences: "But other plans, hoping to attract customers, are increasing their prices substantially less. In some markets, plans are even cutting prices." (The point of the piece is that to get the best price you need to shop around.)
It's easy to give people a skewed impression of Obamacare without ever running a false story. The Affordable Care Act is a huge law, and at any given moment, there are some good things happening in it and some bad things happening in it. If you run multiple articles every day on the problems and nothing on the broader trends, it's easy to mislead your audience.
Recently, one of the major insurers pulled out of the Minnesota exchange. The news received huge play in the conservative media. The story is real — and it's bad news for Minnesotans. It's just not representative of the overall trend towards increased exchange participation. But a lot of conservative readers don't know that. The Daily Caller, for instance, hit the Minnesota story hard. But on Tuesday, they managed to report on Burwell's remarks without even mentioning the new data she presented on rising insurer participation.
My hunch is that relatively few conservatives realize that premiums are lower-than-expected, and that the law's costs are lower-than-expected ($104 billion lower, as of April 2014). (Of course, information loops can go the other way, too: a lot of liberals probably don't know that of the much-discussed 8 million enrollees in Obamacare's insurance exchanges, new data suggests only about 7.3 million stuck around as paying members.)
In wonkier Republican circles, the spin has gotten subtler. They know that premiums are lower than projected and insurers are joining the exchanges. So the argument has developed a good-news-is-bad-news quality.
The fear about government programs in general, and government health-insurance programs in particular, is that they are overly generous because they spend other people's money. So Republicans have, for a long time, been putting forward health-care plans that would devolve single-payer insurance programs like Medicare to private insurers that would hold down costs by narrowing networks and managing care. Then, they figure, Americans can shop around, and the market will reward the plans that hold down costs and punish the plans that don't. These ideas were present in the health reforms Mitt Romney passed in Massachusetts, and Obamacare borrowed heavily from them.
Rep. Paul Ryan has also been a key sponsor of these ideas. But now that they're happening in Obamacare, he's selling it to conservatives like some kind of catastrophe. "I don't think this is the kind of country that is going to stand for being told who and where they're going to get their health care," he told the Washington Examiner's Phil Klein. As Jonathan Chait writes:
Except that very dynamic is exactly the way Ryan's own fabled Medicare plan is designed to work - by having insurance companies lure customers by competing to hold down prices, in part by excluding doctors and hospitals that charge too much. Only now, rather than hold up this scheme of exchanges with private insurers as the silver bullet to solve America's problems, Ryan is exploiting discontent with it. He is implicitly promising that people will be able to go to whichever doctor or hospital they want, regardless of price. Of course he won't say how he'll pay for that luxury, either.
Obamacare's competitive insurance marketplaces are actually doing what they promised to do: forcing insurers to compete for customers by cutting costs. The Congressional Budget Office explains that Obamacare's premiums are cheaper-than-expected because its insurance features "lower payment rates for providers, narrower networks of providers, and tighter management of their subscribers' use of health care than employment-based plans do."
That is an extraordinary sentence: Obamacare is forcing insurers to run leaner than employers are. If Obamacare were Romneycare does anyone doubt Ryan — and Republicans more broadly — would be celebrating?
Obamacare isn't by any means a perfect law and not everything in it is going right. The law powers a different insurance market in every state (plus the District of Columbia), so it is perfectly possible for Obamacare to be a success in California even as there are troubles in Minnesota. And there continue to be operational issues: there have been troubling revelations about web site security, and problems verifying the incomes of some enrollees.
On the whole, though, costs are lower than expected, enrollment is higher than expected, the number of insurers participating in the exchanges is increasing, and more states are joining the Medicaid expansion. Millions of people have insurance who didn't have it before. The law is working. But a lot of the people who are convinced Obamacare is a disaster will never know that, because the voices they trust will never tell them.