Obamacare Covers the Uninsured (and Some Who Weren’t)

The
headline news from last week’s Kaiser Family Foundation
survey of people who enrolled in individual market health
insurance was that more than half—57 percent—of those enrolled in
coverage through Obamacare’s exchanges were previously
uninsured.

That’s a marked improvement over previous outside surveys from

McKinsey and
RAND, which found that 24 percent and 36 percent of
Obamacare-era enrollees were previously uninsured. The surveys were
taken at different times, and they used different questions and
different methodologies, which almost certainly accounts for some
of the variation. But because the Kaiser report is the most recent,
and because it relies on a randomized survey sample, it’s likely to
be taken as the closest thing we have to a canonical number, at
least for now.

Kaiser estimate represents a significant improvement over the
previous estimates produced by McKinsey and RAND, and in that sense
it represents good news for the health law’s supporters. Certainly,
they will now be able to say that a majority of the people covered
through the law’s exchanges were previously uninsured.

But even still, the survey results suggest the potential
limitations of Obamacare’s coverage scheme.It’s not a
precise instrument: More than 40 percent of exchange enrollees were
already insured, suggesting that while Obamacare is expanding
coverage to the uninsured, it’s also resulting in a fair amount of
subsidized coverage going to people who already had coverage (the
vast majority of exchange beneficiaries got subsidies).

Digging a bit deeper into the survey also hints at the
difficulty in measuring who, exactly, counts as previously
uninsured. If someone had health insurance up until a month prior
to getting new coverage under the law, should that person count as
uninsured? Probably not. What about six months before? Or a year
before? These questions are legitimately difficult to answer.

Kaiser’s survey finds that the majority of previously uninsured
lacked coverage for two years, and that 45 percent reported not
having coverage for five years. Which means that more than half of
the previously uninsured were covered at some relatively recent
point.

Now, many of those people clearly were having difficulty getting
coverage for some reason—perhaps as a ripple effect of the
recession, perhaps because of some other factor. But many of them
appear not to be completely uninsurable. These are not people who
couldn’t get insurance under any circumstance. They’re people who
didn’t have it for the last several years.  

Obamacare’s supporters would no doubt say that the law was
designed to help those people just as much as it was designed to
help those who never had coverage at all. That’s an entirely
reasonable position. But when we talk about Obamacare’s coverage
effects, it’s important to be clear about who is being covered: a
sizable number of people who were already insured, as well as
people who were both eligible for coverage and covered at one
point, but had lost their coverage.