Obamacare and the Uninsured

The
Obama administration has said that it is not
“systematically” tracking information on how many previously
uninsured people have gained health coverage thanks to Obamacare.
And a
recent change in the way that the Census tracks coverage rates
means that, when that data is eventually released, we won’t be able
to compare the new results to a multi-year baseline.

That means we have to rely on other sources of information. And
for the moment, one of the best sources is Gallup’s tracking poll.
As I
noted back in March, the survey has shown drops in the national
uninsurance rate since the beginning of the year, when Obamacare’s
coverage expansion kicked in. When the drop first appeared early in
the year, it was possible that it was just a result of
month-to-month variation.

That’s not really plausible anymore. The latest
update shows that the uninsurance rate has continued to drop
over the last few months, hitting 13.4 percent—its lowest rate
since 2008.

After the botched launch of the exchanges last year, there was a
lot of speculation—including from me!—about the possibility that,
between the mass insurance cancellations caused by the law and the
broken website, the law would actually result in a net loss of
insurance coverage. That’s pretty clearly not what
happened. 

It’s still possible that the data is not perfectly precise.
We’ll know more as some of the official estimates come out over the
next year. And these sorts of dramatic gains
may be harder to sustain in future years: Presumably the people
who signed up first are those most motivated, or most easy to
motivate, to get coverage. But at this point it’s safe to say that
Obamacare has helped reduce the ranks of the uninsured.

The survey does suggest some potential challenges for the health
law going forward in terms of who is covered: It found increased
coverage levels in all the under-65 age and ethnicity groups it
measured, but the shift doesn’t look quite as strong among
Hispanics and young adults, two groups that were heavily targeted
by the administration.

Gallup doesn’t break out coverage by type, so we don’t know how
the newly covered are getting their insurance. Presumably, some
proportion are getting covered through Medicaid. And the best
evidence we have about Medicaid, specifically, is that it doesn’t
do much to improve measurable physical health. It’s basically a
financial shock absorber.

Of course, as I noted with regards to the study I wrote
about earlier today, which found a reduction in mortality in
Massachusetts following the implementation of RomneyCare’s coverage
expansion, it’s always helpful to compare any of these gains
against their likely costs. Obamacare requires about $2 trillion in
spending over the next decade. And, yes, that spending is supposed
to be offset by a combination of tax hikes and reductions to
Medicare spending, but even still, that’s $2 trillion that won’t be
spent on something—or many somethings—else. Making policy choices
is about more than finding a positive result and declaring success;
it’s about comparing the results and the costs with the forgone
opportunities.