Campaign Ads Criticize the ACA, But Are the Claims Accurate?

Every time we turn on the TV, we see a new political ad opposing the Affordable Care Act. How do some of these claims stand up to closer examination?

Claim: 355,000 Coloradans have received cancellation notices for health insurance policies.

What you need to know: It's true that thousands of Coloradans were notified in 2013 that their policies would not be renewed in 2014. Note the time frame: It was a one-time event, prompted by provisions in the ACA that required insurance policies to meet minimum standards.

Whether the letters were called "cancellation notices" -- an incorrect term -- or "non-renewal notices" -- a more accurate description -- the reason for the change in most cases was that the policies did not include the ACA's 10 essential benefits. These include preventive-care services and coverage for pregnancy and mental health, and they are designed to ensure that Americans have adequate insurance for health emergencies.

Use of the term "cancellation notice" implies that customers were cut loose, left high and dry. In fact, because of the ACA, insurance companies were required to give customers the option of purchasing an alternative policy. Customers also had the option of buying a competing plan through the health insurance exchange. Those plans had the potential to be cheaper, and if a customer's income was low enough, subsidies could make coverage even more affordable.

Also, after complaints and to help people navigate the new landscape, the Colorado Division of Insurance allowed policyholders to keep non-compliant plans through the end of 2015, as long as the carrier continued to offer them.

Finally, it's worth remembering that the individual market was unpredictable for customers before the ACA. Insurance companies often canceled or changed policies every year, forcing families to scramble for new policies or settle for ones that often didn't meet their needs.

Claim: On the Eastern Plains, patients outnumber their doctors 5,000-to-1.

What you need to know:
This statement, plucked from a broader news story, is true for five counties in eastern Colorado. That's about one-third of the counties east of the more populated Front Range. To put the number in perspective, the ratio in Denver is about 1,300-to-1.

But the larger issue is the implication that the Affordable Care Act is causing or significantly contributing to the problem. That's not true, and in fact, provisions of the ACA are designed to provide more care in underserved areas.

Recruiting and keeping primary-care physicians in rural areas has always been very challenging. Physicians there are likely to be paid less than their urban counterparts, and they are required to treat a greater number of patients with a wide variety of health problems. Also, specialists can be few and far between in rural Colorado.

In response, rural hospitals have to spend extra money to recruit and retain doctors, and that's especially difficult when a very high percentage of rural patients have historically been on Medicaid or were uninsured.

Instead of making the problem worse, as the ad implies, the ACA is trying to help correct the problem. First, the ACA provides scholarships, loans and state grants in medically underserved areas to increase the provider workforce and support residency programs. Second, by expanding Medicaid, rural hospitals and doctors will see fewer uninsured patients, and that may improve the bottom line, making it easier to recruit and retain doctors.

Claims: Health-care costs are still going up ... Some rural residents pay up to 30 percent of their income for health insurance ... Many Coloradans may pay 100 percent more for health insurance.

What you need to know: All of these statements suggest that the ACA is responsible for higher health insurance costs, especially in rural areas.

In reality, health care costs and insurance premiums have historically gone up every year. Between 1999 and 2009, before the ACA became law, health insurance premiums in the U.S. grew by an average of 133 percent.

The real question is whether coverage is more available and affordable under the law than without it. A recent report showed that the percentage of uninsured Coloradans dropped by six percentage points, from 17 to 11 percent, after the ACA took effect.

As for affordability, that depends on a number of individual factors, including income, health status, the specific plan and the level of coverage. For most people in the employer-sponsored insurance market, premium growth is about the same as it was before the law. For Coloradans with lower incomes who purchase insurance in the individual market, coverage may now be more affordable because of subsidies available under the ACA. Coloradans with pre-existing health conditions now have access to insurance coverage for the first time because those exclusions are no longer allowed.

Other factors that affect availability and affordability:

• Older policyholders can no longer be charged more than three times what younger policyholders pay for coverage.
• Women can no longer be charged higher premiums than men exclusively because of gender.
• Carriers have the right to pass costs associated with the two items above on to all of their other policyholders, and that may mean higher premiums for some.
• Some policyholders with higher incomes (who don't qualify for subsidies) may pay higher premiums in the individual insurance market. As mentioned above, all individual health insurance plans now must cover the ACA's 10 essential benefits. That can mean premiums are higher, but the coverage is better.

Insurance companies can still increase premiums in geographical areas where health care costs are high and provider competition is low. Since the ACA eliminated some of the rating factors described above, geographical rating now has a greater impact. As a result, premium rates in some rural areas have significantly increased, especially in ski resort counties. References to 100 percent premium increases (in Aspen and Pitkin County) and rural residents paying 30 percent of their income on insurance (in Summit County) mostly come from resort areas and do not reflect a statewide trend.

Health care has always been more expensive in rural areas. The cost of living is higher in rural resort areas like Aspen and Vail, populations in rural counties are disproportionately older and may need more expensive care, and many rural residents are employed in physically demanding or high-risk jobs. All too often, there is little incentive for rural doctors and hospitals to keep their prices low since they may be the only providers around.

The urban/rural and resort county/non-resort county divide may be less about the ACA and more about bigger issues that still need to be resolved.

The bottom line is that in a health care system as complicated as ours, problems have multiple causes. And a single law can't solve every problem. With these ads, it's best to remember that they aren't really trying to educate the listener or viewer. Rather, they are using selective arguments and trying to score political points.