McKinsey has just released the methodology for its highly contested and controversial survey of the effects of the Affordable Care Act on employers. The report, which Republicans have been using to argue that American’s won’t be able to keep the coverage they have even if they like it, found that up to 30 percent of employers would stop offering insurance. But in the methodology summary just released, McKinsey stresses that the report “was not intended as a predictive economic analysis of the impact of the Affordable Care Act. Rather, it captured the attitudes of employers and provided an understanding of the factors that could influence decision making related to employee health benefits”:
As such, our survey results are not comparable to the health care research and analysis conducted by others such as the Congressional Budget Office, RAND and the Urban Institute. Each of those studies employed economic modeling, not opinion surveys, and focused on the impact of healthcare reform on individuals, not employer attitudes.
Comparing the McKinsey survey to economic estimates, such as the CBO’s, is comparing apples to oranges. While the McKinsey Quarterly article about the survey cited CBO estimates, any comparison is not apt. We understand how the language in the article could lead the reader to think the research was a prediction, but it is not.
So it’s worth reiterating that all other studies of employer responses have found significantly less coverage erosion. After the first 10 years, the Congressional Budget Office estimates that “the number of people obtaining coverage through their employer would be about 3 million lower in 2019 under the legislation.” Actuaries at CMS estimated that just 1.4 million would move out of employer coverage. As the very resent survey of employer surveys from Avalere concludes, “the ESI Market will be fairly stable after 2014 when key ACA coverage provisions go into effect.”
Aaron Carroll looks at the questionnaire and notes: “The whole thing reads like exchanges are awesome, with so many benefits and subsidies, then finally tacks on a line about the penalty. I even missed it the first time I read it. I don’t think they are lying (and never have), but I still believe the question may be biased towards making respondents think harder about dropping coverage.”