Depending on which side you’re listening to during this phase of the health care debate, the Affordable Care Act (ACA) is either a deficit-slashing, job-creating wonder or a deficit busting, job-killing disaster. It’s easy to get confused, especially when lawmakers are throwing around numbers that don’t exactly depict reality. The biggest offenders this week were Republicans, mostly because they were doing most of the talking building up to their symbolic repeal of the ACA. Here’s a look behind this week’s claims.
1. According to House Republicans, the ACA will cause 1.6 million jobs to be lost.
This figure comes from a study conducted by the National Federal of Independent Business, a lobbying group. The problem with this 1.6 million figure is that it comes from analyzing a health reform proposal completely different than the ACA. The NFIB report came out in January 2009, before the ACA was written, and included a mandate that all employers provide insurance. In reality, the ACA exempts employers with fewer than 50 employees and is expected to add hundreds of thousands of jobs to the market as the health services sector expands.
2. According to House Republicans, the ACA will destroy 650,000 jobs.
This alternate figure originated in a report from the Congressional Budget Office that estimated 650,000 Americans may work less or retire early if they’re able to buy health insurance independently and don’t have to depend on their employers for coverage. (The ACA is expected to lower premiums in the individual market.) This is not the same as employers eliminating jobs because of new regulations created by the law.
3. According to House Republicans, the Administration’s own actuary for Medicare and Medicaid says the ACA will dramatically increase, not decrease, spending on health care.
Richard Foster, the actuary, has said overall health care spending will increase because of the ACA, but this is because more people will have health insurance and will therefore seek out care. The increase is not, as Republicans imply, because the ACA will balloon prices.
4. According to House Republicans, the ACA will cost $2.6 trillion and add $701 billion to the federal deficit.
This estimate comes from a report generated by House Republicans and is in direct conflict with estimates from the non-partisan Congressional Budget Office, which estimates the ACA will actually cut the deficit. The CBO says repealing the law will increase the deficit by $230 billion. It is true, however, that this estimate is based on future actions that may not come to fruition – like big cuts in Medicare reimbursement rates. Still, the CBO has long been considered the objective bean counter in Washington and to selectively discount its estimates doesn’t lend much credibility to Republican claims. (For the record, I agree with Republicans that some programs in the ACA are not as fiscally sound as Democrats claim. The CLASS Act is a prime example.)
5. According to the Obama Administration, as many as 129 million Americans have pre-existing conditions and could be denied health insurance coverage without the Affordable Care Act.
It’s true that lots of people have health issues ranging from cancer to back pain. And it’s true that many people with insurance already don’t grasp how vulnerable they could be if they suddenly lost their coverage. Yet, the Administration says the highest rates of pre-existing conditions are among people with job-sponsored coverage. For people who work for larger companies – particularly those that span across states – pre-existing conditions play no role in access to insurance or pricing. In other words, it’s basically an impossibility that, absent health reform, more than 100 million Americans would lack affordable insurance options. As of November – and this number is undoubtedly higher now – just 8,000 uninsured Americans with pre-existing conditions had gotten new coverage because of health reform in so-called “high risk pools.”