In a story about House Budget
Committee Chairman Paul Ryan’s latest 10-year spending
plan, New York Times reporter Jonathan Weisman
says the Wisconsin Republican proposes “total repeal of the
Affordable Care Act just as millions are reaping the benefits of
the law,” a juxtaposition that sounds like a Democratic talking
point. Later Weisman claims “more than 10 million Americans have
gotten health insurance through the law, either through private
policies purchased on insurance exchanges, through expanded
Medicaid or private policies purchased through brokers but
subsidized by the law.”
That estimate apparently includes the 7 miillion or so people
who have picked out plans on the federal or state exchanges, not
all of whom actually have “gotten health insurance,” which requires
paying the first premium. At this point we do not know how many of
the 7 million have taken that step. Furthermore, we do not know how
many are newly covered and how many were previously insured but
switched to the exchanges, perhaps because their old policies were
canceled as a result of Obamacare’s minimum coverage requirements.
Hence it is quite misleading to say that all 7 million “have gotten
health insurance through the law,” which implies that they would
have been uninsured but for the law.
Weisman would have been aware of these two issues if he kept
abreast of my colleague Peter Suderman’s insightful Obamacare coverage—or if
he had read the work of his own colleagues. In a story on the front
page of today’s Times, Michael Shear and Robert Pear
note:
Several of the most ardent critics of the health care law
expressed doubt about the official tally of sign-ups, noting that
the White House had not released information about how many people
who signed up had paid their initial premiums.The critics also noted that an unknown number of people who
signed up at HealthCare.gov had previously been insured under plans
that were canceled. White House officials said they did not yet
have a tally of that category.
How big a difference might these two factors make? Pretty big.
In a recent Forbes post, Avik Roy
cites surveys by McKinsey and the RAND Corporation indicating
that between one-quarter and one-third of exchange enrollees were
previously uninsured. According to the McKinsey survey, only 53
percent of previously uninsured enrollees had paid their first
premiums. Taken together, these findings suggest that the number of
previously uninsured people who have obtained coverage through the
exchanges may be closer to 1 million than 7 million.
Weisman says he is also counting people who obtained coverage
“through expanded Medicaid.” According to a
recent tally by Los Angeles Times health care
reporter Noam Levey, the RAND survey (which has not been published
yet) indicates that “at least 4.5 million previously uninsured
adults have signed up for state Medicaid programs.” Even if all of
those people were previously ineligible, we are still more than 4
million shy of Weisman’s “more than 10 million” claim.
What about people newly covered by “private policies purchased
through brokers but subsidized by the law”? According to RAND’s
survey, Levey reports, “about 9 million people have bought
health plans directly from insurers,” but “the vast majority of
these people were previously insured.” Levey also notes that,
according to data from the U.S. Centers for Disease Control and
Prevention, “an additional 3 million young adults have gained
coverage in recent years through a provision of the law that
enables dependent children to remain on their parents’ health plans
until they turn 26.” But Weisman’s description of his estimate does
not include those people.
Eric Boehlert of Media Matters for America does
include the 3 million adults newly covered by their parents’
plans but, like Weisman, erroneously counts all 7 million exchange
enrollees. Put those two numbers together, Boehlert says, and you
can see that “more than 10 million people have used Obamacare to
secure health coverage.” Well, not quite. CBS News plays it safer,
saying “it’s possible that more than 10 million people have
insurance thanks to Obamacare,” counting the changes to Medicaid
and family plans as well as insurance bought through exchanges.
Levey says “at least 9.5 million previously uninsured people have
gained coverage.”
One point none of these estimates seem to consider is that some
previously uninsured people would have obtained coverage even
without Obamacare. We do not know, for example, how many
25-year-olds would have bought their own health insurance or
obtained it through work had they not been covered by their
parents’ plans. Even some of the people newly eligible for Medicaid
might have found jobs with health benefits and therefore obtained
medical coverage anyway. If we want to measure Obamacare’s impact
on the number of uninsured people, we need to have some idea of
what would have happened in the absence of the law.
The most striking thing about these numbers is that the
exchanges, which were supposed to be the centerpiece of Obamacare,
so far have resulted in new coverage for fewer people than either
the Medicaid expansion or the mandate that family policies cover
children up to age 26. At this point the exchanges look like a
needlessly elaborate and inefficient way of providing medical
coverage to previously uninsured Americans.
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