After a Congressional Budget Office report about the Senate’s Better Care Reconciliation Act, President Donald Trump’s administration attempted to undermine the CBO’s credibility in a tweet, which the president retweeted.
We found that the CBO report written after Obamacare was signed into law in March 2010 indeed estimated 23 million people would participate in marketplace exchanges. According to the latest figures, only 10.3 million currently participate in those marketplaces.
The talking point neglects to mention, however, the CBO report’s accuracy in predicting the uninsured population at a historic low. Given the information available at the time, the agency offered projections closer to reality than any other forecaster.
The Obamacare exchanges are online marketplaces for health insurance, designed to give those who are not covered by employers, Medicaid or Medicare access to coverage from competing private providers.
The CBO originally predicted people would drop employer and non-group coverage to move into the exchanges, and that fewer people would enroll in Medicaid. Instead, fewer employers than expected dropped coverage. And the Republican-led Congress blocked funding for the risk corridor program, leading some insurers to exit the marketplace and to increases in some premiums. More people than expected also enrolled in Medicaid.
Republican-led states also passed restrictions on some of the features designed to boost marketplace enrollment, including enrollment assistance and outreach efforts. The Trump administration continued in this vein, putting an end to all media outreach intended to boost last-minute signups prior to the Jan. 31, 2017 deadline. Already paid-for ads and emails to HealthCare.gov visitors were cut.
The courts also threw a wrench in the CBO estimate about exchange enrollment.
When CBO researchers made their original prediction, they did not know that the Supreme Court would rule against the law’s mandatory Medicaid expansion in 2012. The court determined it was up to the states to decide whether to expand coverage, and 19 states decided against it.
This affected the CBO’s estimate for the uninsured population. (Instead of a reduction of 32 million uninsured by 2016, the count was closer to 20 million.) But it had ramifications for the exchanges, too.
The CBO made another adjustment to its exchange enrollment projection in January 2016, from 21 million predicted at that time to 13 million. The estimate followed the Obama administration's transitional policy that let people keep their pre-ACA health plans through 2017.
The Obama administration at the time said enrollment fell below projections because fewer employees went to the exchanges for insurance as more employers maintained coverage of employees.
The 13 million enrollment estimate is closer to the most recent estimate from a June 2017 news release from the Centers for Medicare and Medicaid Services.
While the CBO overestimated enrollment in the exchanges, it still offered projections closer to reality than four other forecasters (the Office of the Actuary of the Centers for Medicare and Medicaid Services, the RAND Corporation, the Urban Institute; and the Lewin Group).
It also correctly estimated a significant drop in the uninsured population, leaving it at a historic low.
Our ruling
The White House tweet was correct in saying that the CBO had originally estimated that 23 million people would participate in the Affordable Care Act’s exchanges, and that only 10.3 million people currently are participating in these. The White House chose to cite a report that has been updated by the CBO following significant legislation affecting its predictions. The Trump administration cherry-picked a statistic that CBO got the most wrong. The forecasters were closer to actual results on other major components of Obamacare, including Medicaid and employer changes.
We rate this statement Half True.
“When Obamacare was signed into law, CBO estimated that 23 million people would be covered in Obamacare’s exchanges in 2017. They were off by more than 100 percent. Only 10.3 million people are covered by Obamacare.”
— Donald Trump on Monday, June 26th, 2017 in in a tweet
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