The quasi-final 2013 tally for the ACA: more than 9 million insured
Enrollment figures for insurance under the Affordable Care Act are all over the place, largely because the act has so many moving parts: the individual insurance exchanges (federal and state), Medicaid (in expansion states and otherwise), children enrolled in their parents’ employer-sponsored plans.
Keeping track of the numbers requires an obsession. So be thankful that one Charles Gaba has taken on the responsibility. Gaba’s conclusion is that the ACA has brought insurance in one form or another to more than 9 million Americans, possibly 9.5 million.
As Josh Marshall observes at talkingpointsmemo.com, the number would have been much higher if all the states fulfilled their responsibility to bring insurance to their poorest citizens by expanding Medicaid--at federal expense. Estimates are that the refusal of 25 states to do so has left some 5 million of their residents in the cold. (Kudos to Josh for introducing Gaba to a wider audience.)
Gaba, a website developer in the Detroit area who has been compiling publicly available numbers on his own, without pay, has produced what looks like the most authoritative tally. His spreadsheet and an excellent graphic are here. His latest figures show that about 2.1 million people signed up for private insurance through the exchanges. That may understate the total, as some state figures are a week or two behind.
To that should be added some 4.3 million new enrollees in Medicaid or CHIP, the Children’s Health Insurance Program reauthorized by the ACA as an adjunct to Medicaid. Then there’s another 3.1 million young adults (those up to the age of 26) who have enrolled in their parents’ workplace plans since September 2010. That brings the total to 9.5 million.
Not counted are people who have signed up for ACA-compliant health plans directly through their insurers instead of through the exchanges. (The exchanges are mandatory mostly for people seeking premium or cost-sharing subsidies.) Gaba doesn’t estimate that figure, though Marshall guesses it might be 500,000, which does not sound out of line.
These are not all newly insured Americans. Many people listed as enrollees via the exchanges may already have had policies, which were canceled by their insurers either as non-ACA compliant or for some other reason. That number is very murky, and a large number of those customers may be buried within the direct-signup group. That wouldn’t be surprising, since the insurers’ cancellation letters typically included offers of substitute plans.
Whether these figures are impressive, encouraging or disappointing is a philosophical question. But consider that the Obama administration set a target of 3.3 million private enrollees by year-end 2013 in order to reach 7 million by March 31, the last day to sign up for 2014 coverage and therefore for individuals to avoid a penalty for violating the individual mandate.
Since the federal enrollment website, healthcare.gov, was basically out of commission for the first two months of the enrollment period--Oct. 1 through Nov. 30--getting to 2.1 million, or almost two-thirds of the way to the year-end goal looks like a real achievement. Certainly the trendline is distinctly positive. Healthcare experts anticipate another big surge in enrollments, similar to what was seen in the last weeks and days of December, as the March 1 deadline nears.
Gaba observes on his blog that Obamacare skeptics have shifted from questioning the raw enrollment numbers to pointing out that enrollments aren’t final until the first premium bills are paid, which doesn’t have to happen until Jan. 10. The suggestion is that the enrollment figures are inflated by a horde of deadbeats. Gaba doubts this: “Unless there prove to be significant technical issues preventing large numbers of premium payments from going through, this is pretty weak tea in terms of being an anti-ACA talking point,” he writes.
Another emerging anti-ACA talking point we’ve heard is that insurance subject to government subsidies somehow shouldn’t count in the totals, apparently on the argument that those people wouldn’t enroll if not for the assistance. This is even weaker tea. For one thing, the whole point of the ACA is to provide affordable insurance to people in the individual market; how that goal is reached is immaterial.
And it ignores that all employer-sponsored insurance is heavily subsidized, as the employer’s costs and the employees’ premiums are both tax-deductible. Any way you cut it, the ACA enrollment numbers are shifting the earth beneath the feet of the anti-Obamacare crowd.