2018 MIDTERM ELECTION

Time: D H M S

Regarding today's Gallup surveys...

This morning, even as I was posting my official 2015 QHP projection, Gallup came out with two important surveys regarding ACA exchange enrollees:

55% of Americans who currently lack insurance say they plan to sign up for coverage while 35% of the uninsured say they will not get insurance and instead pay the fine as required by the Affordable Care Act, also known as "Obamacare."

 Among those who bought a new policy through a government exchange this year, 68% say they will renew their current policy, while 7% say they plan to get a different policy through a state or federal exchange. Meanwhile, 15% say they will get a different policy from another source, and 2% say they will drop their health insurance altogether.

I addressed the first of these in my "late-breaking update", in which I said:

In theory, if you assume 15 - 18 million who qualify for tax credits through the exchanges, that could conceivably mean 8.25 million - 9.9 million people in addition to the renewals, which would (in theory) bring the #OE2 QHP total up to as high as 16 million people, which would blow away all expectations across the board.

However, this is extremely unlikely to happen. 55% saying they "plan" to get covered doesn't mean 55% will get covered. On the other hand, the 35% who say they'll pay the penalty instead of getting covered could involve a certain amount of bluster, like Democrats or Republicans claiming they'll vote 3rd party who end up "holding their noses" and voting the party line in the end after all.

Another factor here is that the Gallup survey doesn't specify what kind of healthcare coverage that 55% plans on getting. Some will qualify for Medicaid. Some will buy a policy directly through an insurance company (off the exchange). A few may end up getting a job with ESI (employer-sponsored insurance). Not to be too morbid, but some will die (happens to the best of us, after all).

If you assume that the 55% who claim they plan on getting covered actually do, and if you further assume that, say, 2/3 of those actually do so through ACA exchange QHPs, that means around 5.5 - 6.6 million QHPs in addition to the 6.1 million current enrollees who renew and the 1 million or so who swap out cancelled policies through the exchanges. That would mean a grand total of 12.6 - 13.7 million...essentially what the CBO has been sticking to their guns on.

And if that happens, once again, I'd be very happy to be wrong!

Of course, if only half of this group end up getting covered through exchange QHPs, that would be about 4.1 - 5.0 million...for a grand total of 11.2 - 12.1 million, which would be closer to my own call. We'll see.

As for Gallup's second poll, what it basically means is that 75% of the 7.1 million current exchange enrollees say they plan on staying with the ACA exchanges. This is lower than HHS's assumption of 83% and my own assumption of 86%, but it's still a hell of a lot higher than that absurd Bankrate survey, which pegged it at just 49%.

However, just like the "55% plan to get covered, 35% plan to pay the fine", the key word here is plan to. Here's the full breakdown, according to Gallup:

  • 68% plan to renew current exchange policy
  • 7% plan to switch to another exchange policy
  • 15% plan on moving off of the exchanges
  • 2% plan on dropping their coverage altogether
  • 8% don't know what they plan on doing

I strongly suspect that most of the 8% who "don't know" will end up just auto-renewing their policies in the end (perhaps 5%).

I also suspect that perhaps 1/3 (5%) of the 15% who say they're gonna leave the exchanges will end up sticking with it after all, after discovering that without the tax credits, the individual insurance market is a scary place.

Finally, while some people will indeed drop their coverage completely, I'm guessing that in the end a lot of these folks will stick with it after all (see my "3rd party voter" note above).

If I'm correct about this, that means that the retention rate will end up being more like 75% + 5% + 5% + 1%...or 86% after all, which would be a nice feather in my cap. :)