NanoCare Update

The Congressional Budget Office, as you may recall from yesterday's post, warned that a couple million fewer people than originally intended would be covered under the Affordable Care Act (ACA). The CBO today revised that figure yet again, and the outlook is even grimmer: it now predicts, in what it called a "worst case scenario" that 20 million people may actually lose their employer-based coverage in the next decade as a direct result of the legislation.

Then again, three million more people could be covered. Nobody really knows, because all the estimates are based on the future state of the economy, the political state of the states administering the programs and exchanges, and the fact that this is all a great big guessing game based on suppositions and theories and what-ifs. In other words, whether or not we receive medical coverage will still be pretty much dependent on the vagaries of the semi-regulated free market. How sick is that?

Here is the CBO techno-speak in its second press release in 24 hours:

Despite the care and effort that CBO and JCT (Joint Committee on Taxation) have devoted to modeling the health insurance system and the provisions of the ACA, there is clearly a tremendous amount of uncertainty about how employers and employees will respond to the set of opportunities and incentives under that legislation. In response to questions from Members of Congress, CBO and JCT have prepared an analysis showing how the effects of the ACA on health insurance coverage would differ under alternative assumptions about the behavior of employers.

Ohhhh-kay -- whether or not workers get health care will depend not only on the future economy, but also on their employers' mood and behavior on any given day. Hmmm. I guess the bosses are destined to turn into Scrooges, because last year the CBO forecast that only a million poor slobs would lose health insurance through their crapola jobs. They were only wrong by a factor of several hundred percentage points.

The White House is scrambling to contain the damage, dismissing the new CBO report as "what's a few million uncovered people in the grand scheme of things?"  And besides, if fewer people are covered, the budget can be balanced and the deficit cured. Letting sick people stay sick will save the taxpayers a bundle! I wish I were kidding about this tone-deafness, but I'm not. Here's the official line from the Obama Administration blog:

This suggests that taxpayers will save $50 billion more, on net, through 2021 and Americans will pay even less for private insurance than CBO previously projected – which is good news..... the bottom line is clear: the Affordable Care Act will reduce our deficit, control health care costs, and make health care more affordable.

Naturally, the vast majority of people expected to lose their employment-based coverage will be low-wage workers. According to the CBO, of the 11 million poorly-paid individuals to have benefits cut, three million of them will qualify for Medicaid. And then it's always possible that employers who drop or threaten to drop their employee health plans will get "incentivized" to provide at least a modicum of subsidized coverage. The Hill has more.

Math was never my strong suit, so I confess I do not understand all the number crunching and the convoluted prognostications. But then, I suspect, neither do the so-called experts.

Medicare for All, though, where everyone pays a progressive tax based on income? That is eminently understandable, and equitable to boot.