Skip to main content

The context you need, when you need it

When news breaks, you need to understand what actually matters — and what to do about it. At Vox, our mission to help you make sense of the world has never been more vital. But we can’t do it on our own.

We rely on readers like you to fund our journalism. Will you support our work and become a Vox Member today?

Join now

Everyone thought Obamacare would kill private Medicare plans. Everyone was wrong.

(Shutterstock)

When Obamacare first became law, Medicare Advantage plans seemed to be near-certain losers in the deal.

These are the private health insurance plans that contract with the federal government to provide coverage to seniors. And Obamacare cut their reimbursement rates by $156 billion over a decade, in order to help pay for the health law’s insurance expansion.

As a result, the Congressional Budget Office predicted the program’s enrollment would fall from 11.7 million enrollees in 2011 to 7.5 million in 2018.

That’s why it’s so surprising to see that Medicare Advantage enrollment is now at an all-time high, contrary to all expectations. Tricia Neuman from Kaiser Family Foundation recently posted this chart:

ma enrollment

Medicare Advantage enrollment is marching steadily upward while reimbursement rates have moved steadily downward. Enrollment in Medicare Advantage was already on the rise prior to the Affordable Care Act, and it appears the trend has continued post-Obamacare, too.

How did that happen? Medicare Advantage plans seem to be learning to live within their new budgets — which, when you think about it, aren’t actually that stringent. Since 2004, these private plans have earned more per member than the traditional government-run option spends on covering beneficiaries.

The whole idea of the Obamacare cuts was to bring the payments to Medicare Advantage plans more in line with what the federal government spends. You can see that in the figures above: Medicare Advantage reimbursement rates have dropped from 109 percent of what the government plan pays in 2010 to 102 percent this year.

The cuts are significant, for sure. But the decline in enrollment? There just isn’t evidence that it’s actually happening — or will actually happen in the future, either.

WATCH: ‘The dysfunction of the American health-care system’

More in Politics

The Logoff
Trump’s DOJ wants to undo January 6 convictionsTrump’s DOJ wants to undo January 6 convictions
The Logoff

How the Trump administration is still trying to rewrite January 6 history.

By Cameron Peters
Politics
Donald Trump messed with the wrong popeDonald Trump messed with the wrong pope
Politics

Trump fought with Pope Francis before. He’s finding Pope Leo XIV to be a tougher foil.

By Christian Paz
Podcasts
A cautionary tale about tax cutsA cautionary tale about tax cuts
Podcast
Podcasts

California cut property taxes in the 1970s. It didn’t go so well.

By Miles Bryan and Noel King
Podcasts
Obama’s top Iran negotiator on Trump’s screwupsObama’s top Iran negotiator on Trump’s screwups
Podcast
Podcasts

Wendy Sherman helped Obama reach a deal with Iran. Here’s what she thinks Trump is doing wrong.

By Kelli Wessinger and Noel King
Politics
The Supreme Court could legalize moonshine, and ruin everything elseThe Supreme Court could legalize moonshine, and ruin everything else
Politics

McNutt v. DOJ could allow the justices to seize tremendous power over the US economy.

By Ian Millhiser
The Logoff
The new Hormuz blockade, briefly explainedThe new Hormuz blockade, briefly explained
The Logoff

Trump tries Iran’s playbook.

By Cameron Peters