2018 MIDTERM ELECTION

Time: D H M S

In which the Heritage Foundation has a new & shocking revelation which is neither new nor shocking.

I've already taken apart Heritage Foundation shill Sharyll Attkisson for her mind-bogglingly embarrassing FAIL at trying to claim that the uninsured total has only dropped by 3.4 million since the ACA exchanges and ACA Medicaid expansion kicked in on January 1st, when in fact it's actually around 12 million, give or take...a number which has been proven by surveys by not just one, not two, but five well-respected sources, including Gallup, the Urban Institute, the RAND Corporation, the Commonwealth Fund and the New England Journal of Medicine.

Now, it seems, I'm going to have to tackle the Heritage Foundation itself directly. A couple of days ago they released a study which claims that (here's the Abstract)...

New data show that the number of people who have private health insurance increased by just over 520,000 in the six months between October 1, 2013, and March 31, 2014. That was because almost all the gains in individual coverage through the Obamacare exchanges were offset by reduced enrollment in employer-sponsored group coverage. During the same period, Medicaid enrollment increased by about 5 million, principally as a result of Obamacare expanding eligibility to able-bodied adults without dependent children. Because of delays in the exchanges processing enrollments and a “surge” in exchange applications in March, it is possible that a further 3 million to 4 million individuals may have gained individual coverage since March 1. However, even if that proves to be the case, and even if there is no further erosion in employer coverage, more than half of any increase in coverage during 2014 will still be due to Obamacare’s expansion of Medicaid.

Now, to their credit, this study is not nearly as full of shit as Attkisson. Unlike her, they openly acknowledge that Medicaid expansion, you know, exists, and they even acknowledge the fact that "3-4 million" more people "may" have gained individual coverage since the end of their timeframe.

However, everything else in their study is either based on terribly outdated data or, at best, makes declarations which are not only not controversial or shocking, but are exactly what the CBO projected they'd be over a year ago.

They claim that, between 10/1/13 and 3/31/14, the private individual market grew by 2.24 million people (yay!) but that employer-sponsored insurance shrank by 1.72 million during the same time period, leaving a net gain of just 520,000 privately-insured people, not including Medicaid expansion of around 5 million people.

I'm perfectly willing to accept the 1.72M reduction in ESI because a) it's not my area of expertise and b) it makes no difference anyway, for a simple reason. Yes, it's entirely possible that they're correct about there only being a net gain of 520,000 privately-insured people on the individual market as of March 31st...and there's the rub. As they note in their own Abstract, their own study cuts off as of 3/31, and does not include any policies which started coverage as of April 1st or later.

This is important because there's actually a minimum 15-day gap between when you can enroll in an exchange QHP and when the coverage starts. That is, people who enrolled between 1/16/14 - 2/15/14 had their policies start coverage on March 1st...but those who enrolled between 2/16/14 - 3/15/14 didn't have their policies kick in until April 1st.

So, how many people had enrolled in QHPs via the ACA exchanges as of 2/15/14? Around 3.77 million. Tthe total as of 2/01 was 3.3 million even, and around 942K enrolled in February. Take half of that (February was pretty evenly-spaced throughout the month) and you have 471K. Add that to 3.3 million for 3.77 million total.

Next, lop off 10% of that for people who never paid their first month's premium, and you're down to about 3.4 million.

As of today (the end of July) there have been around 7.9 million paid enrollees. This means that the Heritage study, while it may not have technically been "wrong" at the time of the data used, is leaving off the additional 4.5 million paid, private QHPs which have been enrolled in since their study ended...and that's just from the exchanges; this doesn't take into account any increase in off-exchange policies which started on April 1st or later.

Again, they address this by admitting that "a further 3 to 4 million" might have come in "since March 1st" but a) it's actually around 4.5 million via the exchanges plus an unknown number off the exchanges, and b) the policies their study includes appear to have been cut off as of 2/15, not 3/01.

These numbers aside, the last sentence cuts to the heart of why their entire study is rather pointless:

"even if that proves to be the case, and even if there is no further erosion in employer coverage, more than half of any increase in coverage during 2014 will still be due to Obamacare’s expansion of Medicaid."

Um...yes. That's almost certain to be true.

And their point is...?

The Heritage study gives the net gain in Medicaid as of 3/31 as around 5 million, which sounds about right to me. The most recent official CMS report (as of the end of May) has the net gain in Medicaid/CHIP enrollees at around 6.7 million. My own current estimate places this as high as 9.8 million determined eligible for Medicaid (i.e., a couple million applications are backlogged). Given that the CMS report itself 2 months old, the net number actually enrolled is almost certainly 7 million or more by now.

Meanwhile, by my estimates, the net increase in private enrollees (even taking into account those which replaced ESIs) should be around 6 million by now (I had it at 5.7 million at the end of June), for a combined net gain of around 13 million...which is right in line with 4 of the 5 surveys noted above (the Urban Institute one comes in a couple million lower, but the Medicaid/Private ratio is about the same).

This is not only what I've found, but pretty consistent with the CBO's projections from over a year ago: For calendar year 2014 (ie, including the full year, not just through the end of March), they projected around 7 million people enrolling in the exchanges and a net increase of around 9 million in Medicaid/CHIP, with a reduction of around 2 million people from other forms of insurance. 7+9-2 = a net increase of 14 million insured individuals by the end of the year. The source of the 2 mllion reduction was supposed to be from "other" areas instead of ESIs, but aside from that the ACA seems to be right in line with their estimates.

So, yes: At the end of the day, more than half of the net increase in coverage will indeed be on the Medicaid side for the next year or so, at which point the CBO expects exchange enrollment to overtake the lead.

I have no idea why this is supposed to be shocking or controversial, other than as an excuse to try and make it look like the uninsured ranks have "only been reduced by a half-million people", which is a) off by an order of magnitude (10x) and b) shrugs off the 7 million or so added to Medicaid as either nonexistent or some sort of a negative.