Mitt Romney made a damning charge against President Barack Obama's health care reform law during Wednesday's debate designed to give pause to the more than 150 million Americans who get health insurance through their employer.
Citing the Congressional Budget Office, Romney said "up to 20 million people will lose their insurance as Obamacare goes into effect next year." While it's true that a March CBO report said it's possible that many people may move from job-based health insurance to some other form other coverage, Romney misrepresented the budget office's conclusions.
"CBO and the staff of the Joint Committee on Taxation (JCT) continue to expect that the Affordable Care Act (ACA) -- the health care legislation enacted in March 2010 -- will lead to a small reduction in the number of people receiving employment-based health insurance," the agency wrote in a March analysis.
According to the budget office, 3 to 5 million people will switch from job-based health insurance each year from 2019 through 2022.
"CBO and JCT continue to expect that the ACA will lead to a small reduction in employment-based health insurance," the report says. This may break Obama's old promise that "If you like your health care plan, you can keep it," but it's not as dire as Romney indicated.
The health care reform law will extend health insurance coverage to 30 million people who otherwise would be uninsured, according to a separate CBO analysis published in July.
So where did Romney get the 20 million figure? The CBO crunched the numbers under several other different scenarios, acknowledging that "there is clearly a tremendous amount of uncertainty about how employers and employees will respond to the set of opportunities and incentives under that legislation."
Under those alternative calculations the CBO concluded that as many as 20 million fewer people will get health insurance at work -- but that as many as 3 million might actually gain coverage through their jobs.
"Other analysts who have carefully modeled the nation’s existing health insurance system and the changes in incentives for employers to offer insurance coverage created by the ACA have reached conclusions similar to those of CBO and JCT or have predicted smaller declines (or even gains) in employment-based coverage owing to the law," the report says.
Romney cited a survey conducted in 2011 by the consulting company McKinsey & Co. to support his contention. "A study by McKinsey and Co. of American businesses said 30 percent of them are anticipating dropping people from coverage," Romney said.
The White House pushed back against McKinsey's findings at the time, noting that reports by organizations such as the Rand Corporation didn't find large numbers of companies planning to drop coverage.
The health care reform law imposes new requirements on businesses that add new incentives and disincentives. Companies with at least 50 full-time workers have to offer health benefits or pay a penalty, for instance. Some employers may find they can save money by canceling company health benefits; workers would then obtain health insurance on the law's regulated "exchange" marketplaces in their states. Some companies may even increase wages to compensate for the lost benefits.
Most big companies today provide health benefits and are expected to continue doing so, in part because fringe benefits are tax-exempt and in part because they help attract and retain employees. Companies may also use more part-time workers or contractors to avoid the law's requirements so those individuals would have to find their own plans on the exchanges or through Medicaid.