Obamacare’s Subscriber Rolls Include Unpublicized Dental Plans

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OBAMACARE POLICIES

Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, listens during a House Ways and Means Committee hearing in Washington, D.C., U.S., on Tuesday, Oct. 29, 2013.

Photographer: Andrew Harrer/Bloomberg

The Obama administration said it erroneously calculated the number of people with health coverage under the Affordable Care Act, incorrectly adding 380,000 dental subscribers to raise the total above 7 million.

The accurate number with full health-care plans is 6.7 million as of Oct. 15, a spokesman for the U.S. Department of Health and Human Services confirmed today, saying the U.S. won’t include dental plans in future reports.

“The mistake we made is unacceptable,” Health and Human Services Secretary Sylvia Mathews Burwell said on her verified Twitter account. “I will be communicating that clearly throughout the department.”

The error was brought to light by Republican investigators for the House Oversight and Government Reform Committee, using data they obtained from the U.S. Centers for Medicare and Medicaid Services.

“A mistake was made in calculating the number of individuals with effectuated Marketplace enrollments,” said Kevin Griffis, a spokesman for the U.S. Health and Human Services Department. “Individuals who had both Marketplace medical and dental coverage were erroneously counted in our recent announcements,” he said in an e-mail.

The new count puts enrollment short of a 2013 estimate by the Congressional Budget Office, adopted last year as a goal by the Obama administration, that 7 million people would be enrolled this year. Federal officials said in September they had 7.3 million people enrolled in coverage through new government-run insurance exchanges. They didn’t distinguish between medical and dental plans, breaking from previous practice without notice.

No More Dental

“Moving forward only individuals with medical coverage will be included in our effectuated enrollment numbers,” Griffis said.

Blending dental and medical plans let the administration assert that enrollment was more than 7 million. The move also partly obscured the attrition of more than 1 million in the number of people enrolled in medical insurance.

The administration had supplied information about dental plans separately in earlier disclosures. In May, the government reported that 8 million were signed up for health plans and 1.1 million were in dental coverage.

Then in September, the numbers became less transparent. The Medicare agency’s administrator, Marilyn Tavenner, released a new enrollment figure, obtained from insurance companies participating in the exchanges: 7.3 million people were “enrolled in the health insurance marketplace coverage,” she said at a hearing by the Republican-led Oversight committee.

Quietly Added

Tavenner didn’t elaborate or break out dental plans. Reporters asked a spokesman for her agency, Aaron Albright, for more detail on the number after the hearing: He said he had no additional information about it.

“After touting 8 million initial sign-ups for medical plans, four months later they engaged in a concerted effort to obscure a heavy drop-out rate of perhaps a million or more enrollees by quietly adding in dental plan sign-ups to exchange numbers,” Republican Darrell Issa of California, chairman of the Oversight committee, said in an e-mail from a spokeswoman.

Charles Gaba, a Bloomfield Hills, Michigan-based blogger who backs the Patient Protection and Affordable Care Act and has accurately forecast enrollment, was among those who found Tavenner’s announcement encouraging. He had predicted enrollment would suffer attrition of about 3 percent per month; Tavenner’s figure suggested the rate was lower, only about 2 percent.

“This is FANTASTIC news,” he wrote at the time.

He said yesterday that he is “appalled” to find out dental plans were included in the figure.

Shifting Estimates

“I really don’t see what the point would be of being misleading about that number,” he said in a phone interview. “Even if it had been 6.9 million, I don’t see that as being a terrible thing.”

The CBO, which forecasts enrollment under the Affordable Care Act, projected in 2013 that 7 million people would be signed up in 2014 before lowering the estimate by 1 million early this year.

The Obama administration has previously said that enrollment would erode from the 8 million figure. Some customers never paid their premiums or stopped paying. Some may have found alternative coverage, such as through a new job; others may have decided the program wasn’t worth the price.

“Instead of offering the public an accurate accounting, the administration engaged in an effort to obscure and downplay the number of dropouts,” Issa said.

Uninsured Drop

The success of the Affordable Care Act should be measured primarily by one “fundamental number,” the U.S. uninsured rate, U.S. health secretary has said. That number is down about four percentage points this year to 13.4 percent, according to Gallup Inc.

After Tavenner’s announcement in September that 7.3 million people had signed up, aides to the Oversight committee demanded the Medicare agency’s raw data. Weeks of negotiations yielded 289 password-protected Excel spreadsheets, each representing enrollment in a single insurance company’s Affordable Care Act health plans.

In addition to enrollment, the spreadsheets include information such as premium revenue each plan received and the amount of tax credits it was paid by the government, to discount premiums. Dividing total premium revenue by enrollment in the plans, the committee aides noticed that some plans had premiums of less than $60 a month.

The low-priced plans also received little in the way of tax credits. Dental coverage sold under the ACA isn’t eligible for the credits, unless it’s combined with a health plan. In that case, the credit first subsidizes the premium for medical coverage, and anything left over goes to the dental plan.

Critical Threshold

The 7 million threshold appears to be important for the administration, said Douglas Holtz-Eakin, president of the American Action Forum, a Washington advocacy group aligned with Republicans that has opposed the health law.

“It’s a little weird,” Holtz-Eakin, a former CBO director, said. “Usually, the goal is for the forecast to hit the reality, but here the reality is being massaged to hit the forecast.”

The dental-plan data may add to a growing credibility problem for the Obama administration, Holtz-Eakin said. Recently, the administration has rebutted remarks by a former adviser, Massachusetts Institute of Technology economics professor Jonathan Gruber, suggesting that Democrats deceived the public when the law was passed in 2010.

‘They Lied’

“The No. 1 most effective message against the Affordable Care Act is: they lied to you to get it through,” Holtz-Eakin said in a phone interview. “People believe that years now after its passage. The distrust is already there, and they’re doing nothing but exacerbate it.”

Burwell, the health secretary, said at a Nov. 10 event that Obamacare enrollment was 7.1 million in October, 200,000 less than in August, again without breaking out dental plans. “That’s the number of people currently enrolled and paying in the marketplace,” Burwell said at the event, which was hosted by the Democratic-aligned Center for American Progress.

Burwell reported the October number after Ted Strickland, the former Democratic governor of Ohio who moderated the event, asked her to respond to critics who say the Obama administration has not been transparent about enrollment or premiums under the Affordable Care Act.

“In terms of this transparency issue, what we’re trying to do is make sure we’re clear,” Burwell said. “What we try and do is give you information when we have it that’s accurate.”

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