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David Gregory’s Premium Confusion



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This should pretty much be a rule by now: Beware of anchors bearing fact checks. Today on NBC’s Meet the Press, after Democratic representative Barbara Lee of California issued the ludicrous claim that “health-care costs are going down” and Republican Marsha Blackburn took issue with it, David Gregory told his guests he was going to “inject a point of fact here” to clear up the debate about insurance-premium changes under Obamacare. But instead, he muddied the issue and blamed the premium increases in some states on Republican obstructionism, rather than explaining what’s actually happening. Here’s what he said:

[Premiums] have gone up in some states, they’re coming down in other states if they have exchanges. You know full well it depends on who the governor is — if you’re a governor of Florida, you’re inimical to the Affordable Care Act, the feds have to come in and do it. In New York, Democratic governor, they’re having an easier time of it. So it really does matter where you are.

Gregory is right that it matters where you are: Not all states will see large average increases in health-insurance premiums on the individual market, and some could actually go down. But so far, the divergence between states doesn’t have anything to do with the issues he adduces here — whether the state has agreed to set up an exchange, how favorably disposed the state government is to Obamacare, and whether it currently has a Republican or Democratic governor — which, a cynical reader might note, shift blame for “rate shock” onto uncooperative Republican governments.

Instead, rate shock has to do almost entirely with how highly regulated the states’ insurance markets are now and how many and which people currently buy health insurance, which does happen to have a partisan coloring to it.

New York’s health-insurance customers will be “having an easier time of it” not because of anything today’s governor, Andrew Cuomo, has done, but because of something his dad, governor from 1983 to 1994, did: Decades of tight health-insurance regulations have pushed Empire State premiums much higher than they are in the rest of the country, so individual New Yorkers buying health insurance are actually already having a terrible time of it.

Such states (also including New Jersey and Massachusetts) have already seen their premiums shoot up because they haven’t succeeded in getting young and healthy people to sign up for their highly regulated markets. and yes, with bigger, federal subsidies and an individual mandate, premiums may indeed come down in those places — but that’s because of federal changes, not state cooperation.

Twenty-six states, almost all Republican-governed, aren’t setting up their own health-insurance exchanges and leaving it to the federal government to do it, and plenty of them are refusing Obamacare’s Medicaid expansion, too. But this isn’t why their premiums are going up — unless NBC is aware of some research the rest of us aren’t, whether a state is setting up its own exchange or not isn’t going to affect premiums substantially. There shouldn’t be a big difference between the success federally run and state-run exchanges have in signing up new healthy young people for health insurance on the individual market. The degree of success they have at that, and the premiums people pay now and who pays them — determined by what regulations the states already have — will determine whether average premiums shoot up or not. Neither of those things largely depends on the behavior today’s Republican or Democratic state governments, as NBC told its audience. (The Medicaid expansion, since it won’t cover people eligible for subsidies on the exchanges in most states, also shouldn’t be a significant driver of premium changes.)

There probably are some Republican state-level efforts that could potentially affect the success of the exchanges, like attempts to regulate the “navigators” who’ll be marketing the exchanges’ insurance plans — but we have no idea what their effects will be, and it doesn’t seem like they’ll be that significant (huge federal and nonprofit marketing efforts are going on around the country anyway). Rate shock as it’s expected to happen (and has already been seen) is determined by the difference between a state’s individual insurance market now and the market after Obamacare is implemented.

That isn’t up to state governments — except inasmuch as they have shaped their own insurance markets over the course of decades. Which means Gregory is right in an abstract sense: States “inimical to the Affordable Care Act” in the sense that they haven’t already adopted Affordable Care Act–like regulations in preceding decades will see premiums go up. (This category of inimici includes plenty of blue states, such as California.) But that isn’t at all what he was trying to say, and what most viewers will take away from his fact-checking interlude.

Instead, as these drive-by media fact-checkings always seem to go, they’ll be more confused about what’s actually going on. Meet the press, indeed.



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