Tuesday, September 2, 2014

How many people have insurance because of Obamacare?

President Obama probably feels good about most of these numbers. Saul Loeb / AFP

Trying to count the number of people who have signed up for Obamacare? Good luck.

There are about about a half-dozen government agencies, non-profits, and private companies tracking how many people have signed up for the health-care law's new programs. Did it, as budget forecasters predicted, cover 13 million previously uninsured Americans? How many people did it get onto private plans? And what about Medicaid sign-ups?

We won't know the exact number of newly insured for a while. But the latest estimates, with a few precautions, can provide a glimpse into how far Obamacare went in accomplishing its main goal: to cover as many of the uninsured as possible.

Obama administration: 8 million signups on the marketplaces

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The president announced marketplace enrollment numbers on April 1. Pete Marovich / Getty Images Sport

Who it counts: The White House's number covers how many people signed up for Obamacare's marketplaces, which you probably know as HealthCare.gov.

This includes people who have paid their first month's premium and those who haven't. It also includes some people who were previously insured, as well as those buying coverage for the first time. The White House has not published a breakdown of how many of these people have paid or how many are newly insured.

Who it doesn't count:

1) Medicaid enrollees, including those who gained coverage through Obamacare's expansion of Medicaid.

2) Many young adults who, due to Obamacare, can now stay on their parents' health plans until they turn 26. Many in this group were insured before open enrollment began on October 2013, since the health-care law allowed them to enroll on their parents' plans starting in 2010.

Other factors: Some people who signed up for insurance through Obamacare won't pay their premiums and so, in the end, won't get insurance. Health and Human Services Secretary Kathleen Sebelius estimated 80-90 percent of initial Obamacare customers already paid. If that holds up, about 6.4-7.2 million people who signed up for coverage through Obamacare's exchanges are counted as enrolled by their health plan, too.

Obama administration: 3 million enrolled in Medicaid

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HHS Secretary Kathleen Sebelius helped promote Obamacare. Paul Morigi / Getty Images Entertainment

Who it counts: The White House's estimate covers every new Medicaid enrollee from October through February. Not all of these people signed up because of Obamacare: this estimate includes people who gained coverage through the Medicaid expansion and those who were eligible for coverage prior to the new law (but hadn't gotten around to signing up until now).

The report does break up the numbers between expansion and non-expansion states. Expansion states added more than 2.6 million new enrollees from October through February. Non-expansion states, meanwhile, only added 380,000 new enrollees.

Who it doesn't count:

1) People signing up for private insurance coverage through HealthCare.gov and state-based exchanges.

2) Anyone who signed up for Medicaid in March, when the White House reported a surge of signups as people rushed to avoid the individual mandate.

Other factors:

1) Medicaid enrollment is open all year long, unlike Obamacare's marketplaces and employer-based insurance. So people can enroll in June, in August — whenever. So Medicaid enrollment will continue to increase through the year.

2) The estimate comes with a lot of smaller caveats, mostly to reflect the different reporting methods states use. Some states, for example, only report Medicaid-enrolled households, which can reflect a whole family of enrollees, while other states report individuals.

CBO: 12 million newly insured through fiscal 2014

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CBO Director Doug Elmendorf prepares to talk to Congress. Tom Williams / CQ-Roll Call Group

Who it counts: The Congressional Budget Office (CBO) numbers project everyone who gained and lost insurance through fiscal 2014.

The CBO estimates 6 million people gained insurance through the exchanges and an additional 7 million got coverage through Medicaid, while up to 500,000 lost their employer-based plans and another 1 million lost other forms of coverage. That works out to a net gain of 12 million newly insured, according to the CBO.

Who it doesn't count:

1) Many young adults who, due to Obamacare, can now stay on their parents' health plans until they turn 26. Many in this group were insured before fiscal 2014, since the health-care law allowed them to enroll on their parents' plans starting in 2010.

2) Medicaid expansion enrollees who gained coverage before fiscal 2014, because their states expanded Medicaid before Obamacare's expansion funding kicked in.

Other factors: CBO numbers are susceptible to revisions. In February, CBO estimated 13 million would gain insurance through Obamacare. This revision subtracts 1 million from that projection.

LA Times: 9.5 million newly insured since September

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The Los Angeles Times building. David McNew / Getty Images News

Who it counts: The Los Angeles Times' estimate tries to include everyone who is newly insured under the health-care law. This includes marketplace signups, Medicaid enrollees, and under-26 young adults who stayed on their parents' plans.

Who it doesn't count:

1) Many young adults who, due to Obamacare, can now stay on their parents' health plans until they turn 26. Many in this group were insured before open enrollment began on October 2013, since the health-care law allowed them to enroll on their parents' plans starting in 2010.

2) Medicaid expansion enrollees who gained coverage before open enrollment, because their states expanded Medicaid before Obamacare's expansion funding kicked in.

3) Anyone who signed up during the last couple weeks of March, when the White House reported a surge of signups as people rushed to avoid the penalty from the individual mandate.

Other factors:

1) The number is a rough estimate based on a collection of sources, including surveys and preliminary White House data.

2) The Medicaid numbers don't differentiate between enrollees who gained eligibility under the Obamacare-funded expansion and enrollees who qualified even without the expansion.

Urban Institute: 5.4 million newly insured since September

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Americans sign up for health insurance at an Obamacare enrollment fair. Justin Sullivan / Getty Images News

Who it counts: The Urban Institute's Health Reform Monitoring Survey estimates how many adults gained coverage between September 2013 and early March. It includes marketplace and Medicaid enrollees who, prior to September, did not have coverage.

Who it doesn't count:

1) Many young adults who, due to Obamacare, can now stay on their parents' health plans until they turn 26. Many in this group were insured before open enrollment began on October 2013, since the health-care law allowed them to enroll on their parents' plans starting in 2010.

2) Medicaid expansion enrollees who gained coverage before open enrollment, because their states expanded Medicaid before Obamacare's expansion funding kicked in.

3) Anyone who signed up during the last couple weeks of March, when the White House reported a surge of signups as people rushed to avoid the individual mandate.

4) Children. The survey only included adults.

RAND: 9.3 million newly insured since September

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RAND's survey found mixed results for the president's health-care law. Alex Wong / Getty Images News

Who it counts: The RAND Corporation survey counts adults who gained health insurance between September, the month before Obamacare enrollment began, and mid-March. That includes people who got coverage through employers, Obamacare's marketplaces, and public health plans such as Medicare and Medicaid.

In total, the survey found 14.5 million gained coverage and 5.2 million lost coverage in the six-month period. That works out to the net gain of 9.3 million newly insured.

Among the previously uninsured, 7.2 million got coverage through an employer, 3.6 million through Medicaid, and 1.4 million through Obamacare's marketplaces. The rest gained insurance through unspecified sources.

RAND suggested more than 2 million lost coverage after they lost or left a job, and less than 1 million previously held coverage on the individual market.

Who it doesn't count:

1) Many young adults who, due to Obamacare, can now stay on their parents' health plans until they turn 26. Many in this group were insured before open enrollment began on October 2013, since the health-care law allowed them to enroll on their parents' plans starting in 2010.

2) Medicaid expansion enrollees who gained coverage before open enrollment, because their states expanded Medicaid before Obamacare's expansion funding kicked in.

3) Most people who signed up during the last couple weeks of March, when the White House reported a surge of signups as people rushed to avoid the individual mandate.

4) Children. The survey only included adults.

Gallup: Rate of uninsured lowest since 2008

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A woman is walked through the enrollment process. Joe Raedle / Getty Images News

Who it counts: Gallup's survey found the uninsured rate among US adults dropped from 18 percent in the third quarter of 2013 to 15.6 percent in the first quarter of 2014. The rate among blacks and low-income Americans fell by 3.3 and 3.2 percentage points, respectively.

Who it doesn't count:

1) Some people who signed up for Obamacare toward the end of the open-enrollment period. The Gallup survey was conducted between January 2 and March 31, and the Obama administration claims signups on the marketplaces surged near the March 31 enrollment deadline.

2) Children. The survey only included adults.

This story was most recently updated on April 18, with the latest numbers from the White House. Previous updates added the latest enrollment numbers from the Congressional Budget Office and a clarification to indicate the Urban Institute, RAND, and Gallup surveys only counted adults.

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