In the vice presidential debate last night, Rep. Paul Ryan (Wis.) cherry-picked statistics from the Congressional Budget Office on the number of people covered by employer-sponsored health insurance once the Affordable Care Act (ACA) takes full effect. Several fact-checkers (PolitiFact, Washington Post, CNN, Huffington Post, Wall Street Journal, Think Progress) have already challenged his assertion that 20 million people would lose their employment-based health insurance. His number comes from a CBO report, which explored various extreme scenarios for employers under the ACA. That report states: “in CBO and JCT’s judgment, a sharp decline in employment-based health insurance as a result of the ACA is unlikely.”
What’s often left out of this story is the fact that, even in this extreme and unlikely scenario, 29 million more Americans will have insurance (under the ACA). Even if the extreme scenario where 20 million no longer retain insurance through their employer, the vast majority of them will be able to find high-quality, fairly-priced insurance through the new exchanges. Unlike today, the insurance exchanges will be well-run insurance markets where consumers can’t be discriminated against for having pre-existing conditions and where many will be offered subsidies to make insurance affordable. Further, as the CBO estimates, it is expected that those who no longer received ESI would receive “an increase in taxable wages and salaries.”
In that same report, the CBO illustrates another scenario where 3 million more Americans would receive employment-based insurance under the ACA. Their best guess was 5 million fewer, and 31 million more insured overall. So, while the scenario Ryan cherry-picked is highly unlikely, if it comes to bear, Americans without employer-sponsored health insurance will still be captured by the ACA safety net.