Monthly Archives: July 2016

Does Brookings Have a “Wonk Gap?”

Yesterday two researchers at the Brookings Institution released an article claiming that “people are getting more for less” in the individual market under Obamacare.  The piece claims that people are getting “better” coverage, so I asked one of the authors on Twitter: What proof do you have that the coverage is better?  Do people like PPACA plans more than their prior coverage?  Are these new plans leading to better health outcomes for patients?

In an exchange of tweets, Brookings’ Loren Adler said that surveys show people are satisfied with their PPACA coverage — a nice point, but one that doesn’t prove people think it’s “better” than what they had before.  And he admitted that studying the trade-offs PPACA created — in which generally plans have a higher actuarial value, but smaller doctor and hospital networks — “wasn’t the focus of the research piece.”  All well and good, but if that’s the case, why go out on a limb and make an unsubstantiated claim that PPACA coverage is “better?”

He didn’t have a good answer.  He tweeted that the claim of “better” coverage “has nothing to do with the analysis itself of premium comparison,” and that “the wording used in the intro/conclusion has nothing to do w/ analysis itself.”

Think about those words for a second.  Is that the standard we want for research — that people can reach “conclusions” that have “nothing to do with the analysis itself?”  On that basis, I wrote an e-mail to Brookings (pasted below) requesting a retraction or clarification on the specific point that coverage is “better” and people are getting “more” under PPACA.

As I pointed out last night, the Brookings researchers MADE the nature of PPACA coverage a focal point of the analysis, by including unsubstantiated claims to fit a political talking point: “You’re getting more/better coverage for less!”  Having been called out on it, they should prove the claim, or withdraw it.

Folks on the Left complain frequently about a supposed “wonk gap” among conservatives.  I’d be VERY interested to hear from Paul Krugman, or any other observer, who would defend a researcher who makes conclusions that — by his own admission — have “nothing to do with the analysis itself.”

My original e-mail to Brookings follows.  I will update this post as events warrant.

From: Chris Jacobs
Sent: Friday, July 22, 2016 11:32 AM
Subject: Health Affairs Premiums Blog

I’m writing to request a retraction/clarification of the premiums study posted to Health Affairs yesterday.  Your authors claim that PPACA coverage is “better” than pre-PPACA individual insurance, but by one author’s own admission, he did not undertake any research to substantiate that claim.

I communicated via Twitter with Loren Adler about the study last evening.  I asked him what evidence he had to substantiate that PPACA plans — with higher actuarial values than pre-PPACA coverage, but generally narrower networks than prior plans — provide “better” coverage, consistent with the claim in the piece that consumers are getting “more for less.”  Specifically, I asked whether he could cite any studies confirming that consumers desired high-AV, narrow network plans when compared to low-AV, broader network plans.  He replied that surveys suggest people are happy with their current, PPACA coverage — a nice talking point, but one that didn’t really answer the question about whether consumers PREFER their current coverage to prior types of plans.

I also asked what evidence he had that high-AV, narrow network plans actually produce better outcomes for patients when compared to low-AV, broad network plans.  At that point Mr. Adler admitted that the trade-off between network size and actuarial value “wasn’t the focus of this research piece.”

In other words, by their own admission the authors 1) didn’t research whether consumers actually find PPACA plans “better” than their predecessors and 2) didn’t research whether the plans produce “better” health outcomes.  If that’s the case, why does the piece make such unsubstantiated statements?

Mr. Adler attempted to defend doing so by claiming that “the wording used in the intro/conclusion has nothing to do with the analysis itself:”

This tweet implies that the paper didn’t include research to substantiate his claim — but that he’s allowed to say whatever he likes in a conclusion, even if it has nothing to do with the research.  The former implication admits sloppiness, and the latter entirely belies the notion of scholarly research.

Moreover, the way this piece has been portrayed has focused in large part on the conclusion’s sentence that “people are getting more for less” under PPACA.  See for instance here and here.

But the first part of that statement is a political talking point masquerading as factual analysis.  Mr. Adler admitted that he didn’t conduct any research proving that coverage is “better,” or that consumers are getting “more.”  Yet that’s one of the main takeaways being derived from the study.

If Messrs. Adler and Ginsburg want to make unsubstantiated claims that PPACA coverage is “better” without bothering to prove it, they are welcome to do so.  But such work properly belongs at a political organization like the DNC, not at a scholarly think-tank claiming 501(c)(3) non-profit status.  I would encourage you to have the authors clarify, explain, or outright retract that specific claim in the study as soon as possible — and publicize that fact when they do.

The Republican Health Platform and Options for a New President

The platform approved Monday at the Republican National Convention suggests that a future Republican administration could dismantle Obamacare using regulatory authority. A Republican president could not waive portions of the law, but he could act to stop controversial payments that are being made to insurers.

In its section on health care, the platform pledged of Obamacare: “a Republican president, on the first day in office, will use legitimate waiver authority under the law to halt its advance and then, with the unanimous support of Congressional Republicans, will sign its repeal.” The waiver concept echoes language used by 2012 Republican nominee Mitt Romney, who pledged that “If I were president, on Day One I would issue an executive order paving the way for Obamacare waivers to all 50 states.”

The “legitimate waiver authority” provided under the law is unlikely to grant the type of relief the Republican delegates or Mr. Romney envisioned. Language in section 1332 of the Affordable Care Act addresses the waiver of some provisions of the law. The waivers, however, apply only to states, not to individuals. They also apply only to a few delineated sections of the law, including the individual and employer mandates.

As I wrote last July, the waiver authority in the law allows changes in just one direction. States can cover more people or provide more generous insurance coverage than Obamacare does, but they cannot make changes that deviate from the law’s objectives—such as implementing health savings accounts or consumer-directed health plans. This amounts to the administration and Obamacare offering little flexibility to states whose leaders’ philosophical objectives differ from their own. A Republican administration is likely to bring in regulators with a different philosophy, but the statutory strictures would not change unless and until Congress acted.

It’s worth noting, however, that the Obama administration has made several unilateral decisions about a series of supplemental payments to insurers—regarding reinsurance, risk corridors, and cost-sharing subsidies. Because these payments were provided without the usual notice-and-comment period in rule-making, a Republican administration could take its own steps to end the billions of dollars in payments to insurers. If a future president wants to “waive” portions of Obamacare on Day One, these controversial payments would be the most feasible objective.

This post was originally published at the Wall Street Journal’s Think Tank blog.