How The Lewin Analysis Falls Short

On Sunday, former Rep. Rob Portman (R-OH) cited The Lewin Group’s new analysis of Sen. John McCain’s (R-AZ) health care plan to argue that McCain’s proposal “will cover about the same number of uninsured” as Sen. Barack Obama’s (D-IL):

With all due respect, they are very different plans. But the independent evaluations that I’ve seen, including one last week, shows that the McCain plan will cover about the same number of uninsured–in fact, this particular analysis said a few million more people–but it will reduce costs. That’s the key.

Watch it:

According to last week’s Lewin analysis, McCain’s health care plan would reduce the number of uninsured by 21.1 million and cost $2.05 trillion dollars. But the Lewin assessment is the black-sheep of the candidates’ health care comparisons– in fact, the three other prominent analyses of the candidates’ health care plans estimate that McCain would reduce the number of uninsured by just 1-5 million:

Organization Reduction in Uninsured Employer Coverage Non-Group Coverage

Tax Policy Center 1 million in 2009, 5 million in 2013 -20 million by 2018 21 million by 2018
Health Affairs 1 million -20 million 21 million
Commonwealth Fund 2 million -20 million by 2018 21 million by 2018
The Lewin Group 21.1 million -9.4 million 38.1 million

The Lewin Group inflates McCain’s numbers in several ways. Put simply, the report ignores the consequences of opening the health insurance market to unfettered market competition, overstates the purchasing power of McCain’s health credit and the quality of individual health insurance plans.

Admits McCain’s Proposal Would Increase Under-insurance: McCain’s deregulatory approach “could potentially negatively impact consumer protections, and affect costs by increasing under-insurance…we did not estimate the impact of these effects on coverage, quality or system costs,” Lewin notes.

Base-year of 2010 Provides Best-Case-Scenario: Lewin’s “uninsured estimates assume full implementation of these plans in 2010.” But as the Health Affairs study notes, within five years the number of uninsured “will likely grow as the value of the tax credit falls relative to rising health care costs.” See a graph of the depreciating value of McCain’s health tax credit here.

Does Not Account For McCain’s Cuts To Medicare/Medicaid: Lewin assumes that under McCain’s plan, “Medicaid enrollment would remain virtually unchanged.” But a CAPAF analysis of McCain’s proposal to cut $1.3 trillion from Medicare/Medicaid demonstrates that McCain would limit Medicaid growth to 5.5 percent annually (a growth rate that does not keep up with inflation or enrollment growth) and reduce Medicaid spending by $738 billion over 10 years.

Does Not Consider Higher-Out-Of-Pocket Costs: “One reason that non group plans appear less costly is that they offer less coverage…thus, much of the apparent savings from shifting to non group coverage would be offset by higher out of pocket costs for care.” But the Lewin report does not attempt “to estimate increases in out-of-pocket expenditures due to reductions in the comprehensiveness of insurance coverage under the McCain or the Obama proposals.”

Does Not Consider Consequences of Deregulation: Lewin “did not estimate the impact of these effects [McCain’s proposed deregulation the non-group market] on coverage, quality or system costs.” This is quite the oversight. Currently, “insurers will disqualify you for just taking certain medicines because of the possibility of future costs, including common drugs as Lipitor, Zocor, Nexium, and Advair.” McCain’s proposal to allow insurance companies to sell plans across state lines would encourage insurance companies to cherry pick the healthiest individuals and deny coverage to the sickest Americans. McCain’s plan would lock-out sicker people from coverage and encourage healthier Americans to buy less comprehensive policies in the individual market.

Does Not Consider Impact of Breaking Up Large Risk Pools: Lewin argues that under McCain’s plan “about 4.7 million workers and dependents who have declined the coverage available to them at work would now take that coverage with the aid of the new tax credit.” Unfortunately, while the analysis recognizes that “as the size of the uninsured group participating in the employers’ insured plan declines…the premiums will escalate very rapidly,” it does not “estimate the impact of these effects on coverage.”