30 Million (or, it's a lot more than just exchange QHPs)

Last year, I started out tracking just 2 numbers: Exchange-based QHPs and Medicaid via official ACA expansion provisions. As time went on, I gradually added other types of Obamacare-specific healthcare policy enrollments:

  • Off-exchange policies which were compliant with the new law;
  • People who were already eligible for traditional Medicaid prior to expansion (and in non-expansion states) but who were only "drawn out of the woodwork" to sign up thanks to outreach efforts, educational programs and streamlining of the enrollment process in many states
  • People who were transferred over from other existing low-income state-run healthcare programs (often with shaky funding) into Medicaid proper;
  • Enrollees in small business policies via the ACA's SHOP program (granted, this never ended up being more than a rounding error...less than 80K total)
  • Young adults aged 19 - 25 who were allowed to stay on their parent's plan thanks specifically to the ACA

When I added all of these up, the grand total ended up being somewhere between 24 - 29 million people, depending on your definition of what should "count" or not (some feel that "woodworker" Medicaid enrollees shouldn't be counted; others felt that the "Sub26er" number was actually lower than the number touted by the HHS Dept, etc).

This year, I've overhauled and simplified The Graph quite a bit:

  • First, I separated out Medicaid/CHIP onto a 2nd Graph to avoid confusion.
  • Second, I decided to scrap the "Sub26er" category completely; not only was the hard number a bit squirrelly, but the nature of the provision means that most of those who would be counted in this category are already being counted as QHP enrollees anyway, either on or off of the exchanges.
  • Third, since the SHOP numbers were so tiny anyway, I decided not to bother including them unless I saw evidence that they were more than a sliver; so far it doesn't look like this is the case this year either.
  • Finally, while I've been writing about off-exchange enrollments quite a bit lately, I never got around to actually adding them into the Graph mix.

All that being said, if I add everything up together, just how many people are enrolled in their current policies due to the Affordable Care Act or related provisions?

  • Exchange QHPs: Around 9.4 million paid enrollees (this should go up another 1.6 million when the dust settles on open enrollment)
  • OFF-exchange QHPs: Around 7.4 million paid enrollees (this should also go up around another 900K or so)
  • Medicaid/CHIP due to the ACA: 10 million (strict expansion: around 9 million; bulk transfers: around 950K)
  • Medicaid/CHIP "woodworkers": Around 3.3 million
  • SHOP/miscellaneous: No idea, really...not more than 200K or so, I'd imagine.

Add up all of the above and you get over 30 million people if you include the 3.3 million woodworkers. Even if you don't include them, if I prove accurate with my final surge projection, there should be about another 1.6 million exchange enrollees/900K more off-exchange added over the next week, plus hundreds of thousands more Medicaid expansion enrollees throughout the year (no deadline for Medicaid, remember?). Realistically, 30.2 million at a minimum.

Consider this: That's 10% of the entire country in the first 4 years.

UPDATE: I've also re-combined the QHP & Medicaid graphs back into a single image, along with off-exchange QHPs and SHOP (such as it is), assuming my projections through 2/15 hold true. The result will look familiar to anyone who followed the original graph last year (click below for full-sized version):