The nation's top Republican officials, including Donald Trump and Paul Ryan, routinely insist that the Affordable Care Act is beyond repair because it's entered a "death spiral." I've long believed they use this phrase because it sounds terrifying -- they like any sentence that includes the words "Obamacare," "death," and "spiral."
But the phrase is actually a term of art for those who take the policy debate seriously. At the risk of oversimplifying a bit, if the ACA were in "death spiral," we'd see declining enrollment numbers, with consumers withdrawing from the system because they can't afford the premiums and would rather pay the penalty than buy insurance they can't afford. This, in turn, pushes healthier people out of the market, leaving behind sicker people in need of more care, increasing prices in a cyclical and self-defeating way.
As regular readers know, the real-world evidence says this isn't happening. As Larry Levitt, senior vice president at the Henry J. Kaiser Family Foundation, told the Huffington Post in January, "It seems to me that enrollment holding steady amidst tremendous uncertainty about the future of the law and big premium increases is a positive sign. There is no evidence of a market collapse or insurance death spiral."
Complicating matters, it's not just experts reaching this conclusion. Even the Trump administration agrees that Trump's rhetoric is wrong. FiveThirtyEight explained this morning:
The Centers for Medicare and Medicaid Services, which is part of the Department of Health and Human Services, last week released a report about a wonky aspect of the Affordable Care Act related to insurance payments. Tucked away in the report, however, was evidence that the health insurance marketplaces set up by Obamacare were relatively stable in 2016.Contrary to the "death-spiral" narrative, the CMS report found that the mix of healthy and sick people buying insurance on the Obamacare marketplaces in 2016 was surprisingly similar to those who enrolled in 2015.
Remember, before the ACA's critics start shouting, "Fake news!" this data came directly from the Trump administration itself.
Here's the report from Centers for Medicare and Medicaid Services, a key part of Tom Price's HHS. Someone might want to make sure the White House and the Speaker of the House have a copy.