END OF 2018 OPEN ENROLLMENT PERIOD (41 states)

Time: D H M S

Even the Heritage Foundation admits net uninsured population dropped by over 8.5 million as of June 30th!

Hat Tip To: 
Adam Goldstein

I wouldn't normally give much thought to the Daily Signal, seeing how a) it's an offshoot of the right-wing Heritage Foundation and b) the last time I analyzed one of their pieces it was this idiotic piece by Sharyl Attkisson. However, supporter Adam Goldstein asked me to check out their latest, so I did...and while it's heavily biased against the Affordable Care Act, I find it noteworthy that even these wingnuts are willing to concede that a) their own colleague, Ms. Attkisson, was pathetically wrong and b) the net reduction in the uninsured rate nationally thanks to Obamacare is actually off to a pretty good start:

Our analysis of the data is reported in more detail in our latest paper, but our key findings are that in the first half of 2014:

  • Enrollment in individual-market plans (both on and off the exchanges) increased by 6,254,564 individuals.
  • Enrollment in private employer-sponsored group plans declined by 3,788,978 individuals.
  • In the states implementing the Obamacare Medicaid expansion, enrollment in Medicaid grew by 5,716,977 individuals.
  • In the states not implementing the Obamacare Medicaid expansion, enrollment in Medicaid grew by 355,674 individuals.

Applying a little arithmetic to those four key data points yields the following observations:

  • The drop in employment-based coverage offset 61 percent of the gains in individual-market coverage, for a net increase in private-sector coverage of 2,465,586 individuals.
  • Total Medicaid enrollment increased by 6,072,651 individuals, with 94 percent of that growth occurring in the states that adopted the Obamacare Medicaid expansion.
  • The total, net increase in health insurance coverage (private-market and Medicaid combined) during the first half of 2014 was 8,538,237 individuals, but 71 percent of that coverage gain was attributable to Obamacare expanding Medicaid to able-bodied, working-age adults

Now, I haven't delved into their methodology for arriving at these numbers, but assuming that they're on the up-and-up (and I'm not saying they are), what does this mean?

Well, first of all, this only runs through June 30, 2014. According to my exchange QHP graph, the number of people enrolled and paying their premiums for exchange-based private policies as of 6/30/14 was roughly 7.1 million people. Heritage is basically suggesting that perhaps 850,000 people moved from pre-ACA off-exchange private policies to exchange-based ones, which sounds reasonable to me (after all, my wife and I were among these).

Of course, this also means something else rather interesting: Remember the "OMG!! 5MM POLICIES CANCELLED!!!" claims from last year? Well, I showed evidence months ago that the number of policies actually cancelled turned out to only be around 1-2 million at most.

The total individual insurance market last year was around 11 million people pre-ACA, and by Heritage's own admission it's increased to around 17.2 million since then. Since about 7.3 million of these are enrolled through the ACA exchanges, that means around 10 million are enrolled in private policies off of the exchange (I estimate this to be around 8 million QHPs plus another 2 million "grandfathered" policies, give or take).

If 850,000 moved from noncompliant pre-ACA policies to compliant ACA exchange policies, and a slightly higher number moved from noncompliant pre-ACA policies to compliant off-exchange policies, that would add up to about 1.8 million total...right in line with my "1-2 million cancelled" estimate.

In any event, how do the other numbers from the Heritage foundation measure up against my own estimates from June?

PRIVATE POLICIES: 6.35 million newly enrolled (4.85M exchange + 1.5M off-exchange) vs. 6.25 million (on + off)

MEDICAID: 6.1 million newly added (2.1M exchange + 4M off-exchange) vs. 6.07 million (on + off)

As you can see, the numbers are remarkably close to each other.

So, where's the difference? Well, the Heritage study claims that the net number of people insured through their workplace has dropped by a net of about 3.8 million people. They use a study from "Mark Farrah Associates" as the basis for this estimate. I'm in no position to comment on whether this number is accurate or not.

However, they're way off on the net increase in Medicaid enrollment (and, for that matter, so was I at the time)! The official June CMS report clearly states that as of June 2014, 66.1 million people were enrolled in Medicaid/CHIP, vs. the 55.4 million as of December 2013 according to the very study that Heritage themselves use. That's a net increase of 10.7 million, not 6.07 million.

Even if you use the higher September 2013 starting figure for Medicaid (as the CMS reports do), the net gain through June 2014 was still 7.2 million, or 1.1 million more than either one of us estimated.

Either way, Heritage's claims still don't explain why not one, not two, not three, not four but five separate respected national surveys pegged the net reduction in uninsured as being over 10 million as of the end of June...and even if that was overestimating things a bit at the time, it was almost certainly up to that range by the end of the third quarter of the year, since currently-enrolled exchange QHPs were up by another 200K - 400K and 1 - 2 million respectively as of the end of September.

In other words, even if Heritage was accurate about the net uninsured decrease being "only" 8.5 million in June, it's almost certainly up to around 10 - 11 million by now.

Of course, this isn't even the main thrust of the Heritage article. Their real point isn't so much to claim that the uninsured rate hasn't dropped, it's to claim that:

...71 percent of that coverage gain was attributable to Obamacare expanding Medicaid to able-bodied, working-age adults.

Ah. Yes. THAT'S their big beef here...they're not upset that a ton of people are getting insurance who didn't have it before, they're upset that 2.5x as many are getting it for free than are having to pay for it.

To which I respond: So what?

Yes, that's right: I'm a hard-working, middle-class taxpayer who has run a successful small business for 15 years, and if I had investment income over $200,000 per year (remember, that's not even part of my normal income), I'd have no problem paying a few percent extra to help provide insurance coverage for those less fortunate than I am.

This is not because I'm a good and decent human being.

There's a famous quote by author John Green which has gone viral recently, in which he states, "Let me explain why I like to pay taxes for schools even though I don't personally have a kid in school: I don't like living in a country with a bunch of stupid people."

Well, here's why I'm OK with paying taxes for others to have Medicaid even though I personally have decent insurance: I don't like living in a country filled with sick people sneezing on my cheeseburger or coughing up blood on the produce at the grocery store.