Why ACA Has Become Politically Irrelevant in the 2012 Campaign

Why did the health care debate in this year’s election campaign pivot so quickly from the Affordable Care Act to Medicare?

It may well be because of this:  While people still feel strongly about ACA, they don’t really see it as relevant to them.  But Paul Ryan made Medicare relevant to everyone when he proposed changing the program for the under-55 population.

Some new data from the U.S. Census Bureau may explain why most people don’t see ACA as relevant to them.

We learned this month that the number and percentage of people without health insurance changed modestly in the year after ACA passed.  The number of uninsured people went from 50 million to 48.6 million.  The percentage of uninsured decreased from 16.3 percent to 15.7 percent.

These changes were small, as were some others.  The percentage of people with employer-based insurance decreased slightly, from 45.7% in 2010 to 45.1% in 2011, and the percentage of people who purchase private insurance directly remained the same, at 3.6%.

Despite rumors of a “government takeover” of health insurance, government programs also experienced modest changes.  The Medicaid population grew from 48.5 million, or 15.8% of the population, to 50.8 million, or 16.5%.  Medicare recipients grew by 2 million, from 44.9 million people (14.6%) to 46.9 million people (15.2%).   

And the populations experiencing the biggest gains because of ACA aren’t very big when compared to the population as a whole.

• Nearly 3 million young adults under the age of 26 are covered on their parents’ insurance plans as a result of ACA, but they represent less than 1% of the population – and some were already on their parents’ plans before ACA passed because they were still in school.
• Approximately 3.6 million Medicare donut hole recipients saved drug money in 2011 because of ACA, but they also represent only about 1% of the population – and they were already on the Medicare program anyway.
• 4.5 million early retirees remained on employer plans after ACA – but many of these had been on those plans anyway; it was the plans that became eligible for financial relief under ACA.
• Approximately 13 million people got insurance rebates because of ACA in 2012, but many of those rebate dollars were credited to employers, not to individuals.  Perhaps another 1% of the population – one third of those covered by individual insurance only – actually received the full value of the rebate in the form of a check.

These numbers are just big enough to elicit a yawn from more than 95% of the population.

And most of us may keep yawning in the future.  According to 2012 data from the Center for Medicare and Medicaid Services, the percentage of our nation’s health care bill paid by private insurance in 2011 was 34%.  The percentage private health insurance will be paying in 2021, after ACA is fully implemented, will be 33%.

Just as ACA changed the political landscape in 2010 because of how much people worried about what it might do, it may have little effect in 2012 because of how much it hasn’t done.

And even after ACA is fully implemented in 2014, many of us might not notice.  Up to 30 million uninsured people may gain insurance – an extraordinarily significant number – but they still represent less than 10% of the population.

When you add it all up, here is one way to quantify the change to which we can look forward.

Out of every 20 people today, 9 have employer-based insurance only, 1 has individual insurance only, 3 are on Medicare (sometimes in combination with Medicaid), 2 are on Medicaid alone, 1 has another type of government plan, 1 has a combination of coverage, and 3 are uninsured. 

When ACA is fully implemented, in that same group of 20 the number of people purchasing insurance directly will eventually increase from 1 to 2, the number on Medicaid will increase from 2 to 3, and one will still be uninsured.

That’s it.

That’s why the campaign debate has pivoted to the future of Medicare.  

When Paul Ryan proposed making changes to Medicare that affect the under-55 population and when Mitt Romney chose him was his vice-presidential candidate, they took a program that until now has mattered mostly to the 55+ population (Medicare and near-Medicare recipients) and made it relevant to everyone.

And just like that, the political landscape shifted.

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