Playing the Obamacare Numbers Game

Perhaps you remember about Obamacare? Do you remember all the pomp and circumstance that surrounded the administration’s triumphant announcement when the enrollment numbers for the Affordable Care Act (ACA) surpassed seven million enrollees on the insurance exchanges? Seven million was the number they first said was needed to be reached for the ACA to be sustainable, then denied they ever said it, but then celebrated when they passed it. And then, after extending the enrollment deadline, the Obama White House was even more excited to announce that it had passed the eight million mark.

Of course you do. It was hard to miss. And these pronouncements of success on the part of Democrats and the president were simply lapped up by the media, boosting the amazing story of Obamacare’s comeback. While reporting these figures, many in the media left a few real questions not only unanswered, but even unasked. Among them was the question of how many people had enrolled but had not paid their first premium. But most important was the question that should ultimately be the question that the ACA’s success is measured by. How many of the people who signed up for plans had not previously been insured?

This question is crucial, when you consider that the ACA, according to the most recent CBO (congressional budget office) estimates, will be costing somewhere between 1.5 and 2 trillion dollars over the next 10 years. (Because, hey, what’s 500 billion dollars between friends, right?) So is it worth the money?

A McKinsey survey in May called the effectiveness of the law into doubt when it found that 74% of those who signed up for insurance on the exchanges were previously insured. The law’s defenders tried to ignore that study, and instead talked about how the survey found that almost 90 percent — 87 percent to be precise — of enrollees had activated their plans by paying their first premiums. (Of course, they ignored the reality that knocking 13 percent off the eight million number meant that they had fallen off the magic number of seven million that was needed for the exchange to be sustainable.)

They also said that the McKinsey number didn’t account for all the people who had gained coverage through the expansion of Medicaid, for which the enrollees did not have to pay at all for coverage. This is true; McKinsey did not include these people in the survey, which means that we have no idea if those numbers were the same for the Medicaid expansion. It did not mean, as ACA apologists acted as though it did, that the Medicaid enrollees were all newly insured.

Fast forward to last week, when the National Health Interview Survey was released. This survey, according to The New York Times report on it, is “considered a gold standard by researchers.” What it found is only a shock if you hadn’t been paying attention.

According to this survey, the number of uninsured fell in 2014 from the previous year by a total of 3.8 million people.

But that’s not all. You see, this survey wasn’t a survey on the effectiveness of the exchanges. It was a survey on general health issues in America. And as such, it means that the 3.8 million figure includes those who qualified for expanded Medicaid — and the regular yearly decline in the uninsured.

Time for some math. According to a White House fact sheet released on April 17, 8 million people signed up on the exchanges, 3 million people gained coverage by being able to remain on their parents’ plans, and another 3 million were newly enrolled in Medicaid. That’s a total of 14 million people. McKinsey’s survey had just 26 percent of exchange enrollees being previously uninsured. But if you expand that percentage to the entire 14 million, it would mean that a little more than 3.6 million people gained coverage. It appears they weren’t that far off. (Obviously this is very imprecise, but we can get some idea from these numbers as to what really is going on. We are also assuming the entire drop is ACA exchange/expanded Medicaid enrollment-based, despite the fact that the drop is less than a tenth of 1 percent larger than it was the previous year.)

The 3.8 million number however, apparently doesn’t include some of the enrollees in March, who wouldn’t think they were covered until April. But as of March 1, 4.2 million were already enrolled in the exchanges, and 2.6 million people had signed up for expanded Medicaid. (The 3 million on their parents’ plans remains unchanged.) Using those numbers, we have a total of 9.8 million. If only 3.8 million of those were newly insured, it would mean that around 61 percent of enrollees had insurance without the ACA. The real number is obviously higher, because while we removed all the March enrollees, the study counted only a portion of them. But applied toward the 14 million total President Obama touted, it would mean that less than 5 and a half million people gained coverage because of the ACA.

Which, all in all, doesn’t seem like it was worth it.