What Fox Won't Tell You About Health Care Enrollment Numbers

Fox News downplayed the surge in health care enrollment numbers to stoke fears about the Affordable Care Act (ACA), ignoring options to renew health plans, tax credits, and Medicaid enrollments while falsely claiming that 7 million enrollees were necessary for the law's success.

Fox Predicted The Implosion Of The ACA Using Misleading Numbers

Fox News: Without 7 Million People, The ACA “Will Go Into [A] Death Spiral And Implode.” On the January 2 edition of Fox & Friends, co-hosts Steve Doocy and Elisabeth Hasselbeck claimed that 7 million people were needed to “pay for the program” and had to sign up “for this thing to work,” and criticized the Obama administration for signing up 2.1 million people while canceling 4.7 million plans:

HASSELBECK: We heard a long time ago and for a long time that the 7 million goal signup was there, but look at the numbers here. So 4.7 million plans have been canceled. Unreal. And then 2.1 million plans have been added. So they're giving us that number of 2.1 which seems suspicious to some. Right? But that whole -- remember the 7 million that they needed to actually pay for the program? Well, long-time adviser of President Obama, he's actually there part of his transition team when he came into office, Phil Schiliro, he's a White House adviser now, he basically said that 7 million was just irrelevant, it was not really there.


DOOCY: There was magic to the 7 million number. They had to have 7 million people sign up for this thing to work. And if they didn't have that number with a lot of young healthys, the thing will go into [a] death spiral and implode. [Fox News, Fox & Friends, 1/2/14]

But 7 Million Enrollees Was A Projection, Not A “Necessary Benchmark”

The Wash. Post's Wonkblog Confirms 7 Million New Enrollees Was A Projection, Not A Necessary Benchmark. A December 30 post from Washington Post's Wonkblog explained that the 7 million number was just a prediction of how many insurance policies would be sold through the federal exchange and not “some magical benchmark, where the Affordable Care Act suddenly has the manpower to work”:

This past February, well before HealthCare.gov opened for business, the Congressional Budget Office made a prediction. The nonpartisan agency projected that the federal exchange, alongside 14 state run Web sites, would sell 7 million people insurance policies in 2014.

The number quickly became the political benchmark for the health law's success or failure, a ruler by which to measure the success of a largely unprecedented insurance expansion.

White House officials used it when they talked about how many young people they needed to sign up. Health and Human Services forecasted out, month by month, how many sign-ups they would need to get to 7 million.


And, as health policy experts are very quick to point out, hitting 7 million enrollees isn't some magical benchmark, where the Affordable Care Act suddenly has the manpower to work. If the Congressional Budget Office had projected 5 million sign-ups this year -- or 15 million -- we'd have a much different measuring stick. What seems to matter more is the mix of who signs up, whether they tend to be older and sicker -- or include lots of healthy, younger people, too. While the White House has repeatedly promised demographic information, it has not yet released this type of data. [The Washington Post, Wonkblog, 12/30/13]

CBS: Mechanisms Built Into The Affordable Care Act Work to Prevent A “Death Spiral.” In a December 27 CBS News article, Stephanie Condon explained that the CBO projection of 7 million is not critical for the Affordable Care Act's success, and concluded that a death spiral is unlikely to happen due to mechanisms built into the law to prevent problems with cost. Condon also reported on a study conducted by the Kaiser Family Foundation that showed “even if young adults only made up 25 percent of the market rather than 40 percent, overall costs in individual market plans would only be about 2.4 percent higher than premium revenues”:

The concern has been that if only older, sicker people join Obamacare, the costs of covering that market would leader to higher premiums. That would, in turn, prompt even more healthy people to leave the market, leading to the dreaded “death spiral.” The death spiral is unlikely to happen in large part because of mechanisms built into the Affordable Care Act to prevent that. In fact, even if far fewer young, healthy people sign up than expected, the impact on the Obamacare markets would be relatively minimal, some argue.

“Even in what I think is a worst-case enrollment scenario, premiums would only go up by two-and-a-half percent,” Larry Levitt, a senior vice president at the Kaiser Family Foundation, told CBS News. “It would be better to get a good mix of enrollees, but it wouldn't make or break the program if you don't.”

Levitt and his colleagues at Kaiser Family Foundation simulated the effects of two different enrollment scenarios. They found that even if young adults only made up 25 percent of the market rather than 40 percent, overall costs in individual market plans would only be about 2.4 percent higher than premium revenues. Given that insurers set premiums to achieve a 3-4 percent profit margins, they'd still be making money. They would, however, likely pass on that increased costs to customers in the form of higher premiums -- though hardly high enough to risk the “death spiral.”

Even if enrollment is very low by the end of March -- with relatively few younger, healthier customers -- the market will have a chance to recover. Rick Curtis, president of the Institute for Health Policy Solutions, co-wrote an article pointing out that a substantial number of people should be expected to enroll in an Obamacare plan during “special enrollment periods,” which accommodate people experiencing certain life changes such as becoming a citizen, getting married, or moving to a new coverage area. [CBS News, 12/27/13]

Fox Obscured Recent Success In Enrollment Numbers

Wonkblog: Enrollment Numbers May Actually Be On Track To Reach Original Estimate. A December 30 post from Wonkblog reported that health policy experts predict that the law has a chance to hit Congressional Budget Office's (CBO) original estimate of 7 million enrollments by March 2014:

But what seemed impossible in October suddenly became a lot more plausible in late December. This weekend, new enrollment data showed approximately 2 million Americans signed up for private health insurance plans since the start of open enrollment. Health policy experts now see a space to get to 7 million -- although it's by no means a guarantee.


Avalere did its own projections for health law enrollment, modeling what the numbers would look like if shoppers signed up at the same rate as they did with Part D, the Medicare drug program that launched in 2006. Not accounting for HealthCare.gov's massive technical issues, they had expected 2.4 million people to gain coverage by the Jan. 1 deadline.

In the Part D experience, 34 percent of the first-year enrollees signed up to get coverage at the very first opportunity. Right now, 2 million Obamacare enrollees works out to about 28 percent of the 7 million figure.

“Where they are, with about two million enrolled, if they continue to enroll at the present rate, and there's a little acceleration at the end, they could get to seven million,” Mendelson says. [The Washington Post, Wonkblog, 12/30/13]

And The Network's Scare Tactics Over Canceled Plans Were Vastly Exaggerated

The Wash. Post's Plum Line Blog: 4.7 Million Cancellations Ignores Option To Renew And Tax Credits. A December 31 blog from Washington Post's Plum Line blog cited a new report from the minority staff of the House Committee on Energy and Commerce to point out that not only is the 4.7 million canceled care plans a questionable estimate, but that this number fails to account for those who have the option to renew their 2013 plans as well as those who are eligible for tax credits and Medicaid:

Now, a new report from the minority staff of the House Committee on Energy and Commerce has destroyed the foundation of that particular GOP claim. It projects that only 10,000 people will lose coverage because of the ACA and be unable to regain it -- or in other words, 0.2 percent of the oft-cited 5 million cancellations statistic.

The report starts with an assumption that 4.7 million will receive cancellation notices about their 2013 plan. (Notably it doesn't endorse that figure, just takes it on for the sake of argument.) But of those, who will get a new plan?

·         According to the report, half of the 4.7 million will have the option to renew their 2013 plans, thanks to an administrative fix this year.

·         Of the remaining 2.35 million individuals, 1.4 million should be eligible for tax credits through the marketplaces or Medicaid, according to the report. [The Washington Post, The Plum Line Blog, 12/31/13]

House Committee On Energy And Commerce Report: 99 Percent Of Those Receiving Cancellation Notices And Unable To Renew Have Access To Catastrophic Coverage. A report from the Committee on Energy and Commerce showed that the claim that 5 million people will lose health coverage is “baseless,” and that less than 0.2 percent of the 4.7 million people who receive cancellation letters will actually be unable to enroll in other plans:

The individuals with health insurance in the individual market in these eighteen counties in Washington represent approximately 8% of the insured population of the state.25 If individuals who receive cancellation notices are evenly distributed throughout the state, there will be only 24,000 individuals in these eighteen counties who receive cancellation notices. Of these 24,000 individuals, 60% are likely to be eligible for tax credits or Medicaid. This leaves fewer than 10,000 people nationwide who would be unable to renew their cancelled policies, unable to receive subsidized coverage through the marketplace or Medicaid, and unable to enroll in catastrophic coverage. This represents less than 0.2% of the 4.7 million people who will reportedly receive cancellation letters.


Of the reported 4.7 million people who receive cancellation notices, 2.35 million should have the option to renew their 2013 coverage. An additional 1.4 million should be eligible for tax credits through the marketplaces or Medicaid, which will provide them more comprehensive coverage at lower rates. Of the remaining individuals, only 10,000 individuals in 18 counties in a single state would be unable to access a catastrophic plan, and many of these individuals may sign up for coverage through their state exchange. [House Committee on Energy and Commerce, December 2013]

The Atlantic: 3.9 Million “Eligible For Medicaid And The Children's Health Insurance Program.” In a December 31 article in The Atlantic, Garance Franke-Ruta reported on three major numbers in recent Obamacare news and confirmed that more than “2.1 million have enrolled in private-sector health insurance through the state and federal exchanges,” while “3.9 million people were determined eligible for Medicaid and the Children's Health Insurance Program”:

More than 2.1 million have enrolled in private-sector health insurance through the state and federal exchanges. This is more than a million people short of projections for the first three months of open enrollment and doubtless reflects the fact that the federal Healthcare.gov website was only truly functional for about one of those three months. But it also represent an astonishing recovery by the program from its original disastrous launch, raising hopes that it might even make the original goal of enrolling 7 million by the end of March 2014.


3.9 million people were determined eligible for Medicaid and the Children's Health Insurance Program during just October and November, though it's unclear how many have enrolled yet. Still, that's a big number for only the first two months of determinations, before interest in enrollment had its big surge in December. That number would have been much, much bigger, if not for the Supreme Court decision that allowed states to opt out of expanding the federal health insurance program for the poor. Two of the states with the most uninsured, Texas and Florida, opted out of expanding Medicaid eligibility. [The Atlantic12/31/13]

Wonkblog: “At Least 6 Million People Have Signed Up, Or Been Found Eligible, For The Health Law's Two Main Coverage Programs.” Washington Post's health care policy experts Sarah Kliff and Ezra Klein reported that enrollment in the Affordable Care Act's exchanges have increased dramatically since the original implementation, leading to at least six million consumers enrolled in coverage due to the law:

At least 6 million people have signed up, or been found eligible, for the health law's two main coverage programs. A lot of them signed up in December, which you can see in this chart.           


We know that at least 2.1 million people enrolled in private health-insurance plans that start this month -- and there could be more, since HealthCare.gov hasn't published any sign-up information since the end of November. An additional 3.9 million have been found eligible for Medicaid, meaning they have an income below 133 percent of the federal poverty level (about $15,000 for an individual). [The Washington Post, Wonkblog, 1/1/14]