2018 MIDTERM ELECTION

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HHS Dept. INCREASES estimate of net ACA coverage gain to 17.6M

Remember back in March when the Assistant Secretary for Planning and Evaluation (ASPE) released a report stating that there's been a net increase of 16.4 million people with health insurance coverage specifically due to ACA provisions since it was signed into law in 2010?

At the time, I stated that as much of a supporter as I am of the ACA, I was a bit uneasy with this particular estimate, mainly due to the 2.3 million "Young Adults on Parents Plan" portion of it:

The first thing you'll notice right off the bat is that I'm treating the "additional" 2.3 million young adults in the second bullet point as a sort of afterthought.

This is not because I think that these people "don't count". Anyone who's been reading this site since I launched it a year and a half ago knows that I touted the "Sub26ers" as much as possible for the better part of a year.

HOWEVER, long-time readers will also remember that the original number of "Sub26ers" covered specifically by ACA provisions prior to the exchanges being launched which was touted by the administration was 3.1 million. This number ended up being extremely difficult to pin down, however. Just when I thought it had been confirmed, a bunch of new data and analysis came in which made it clear that it wasn't nearly so clear. I eventually converted my estimate of the number of 19-25 year olds covered specifically due to the ACA's "stay on your parents' plan" provision as being somewhere between 1.6 - 3.1 million people.

Today, a year later, the official number claimed by the HHS Dept. is 2.3 million...which on the one hand is right in the middle of the range I settled on (seriously...it's right in between 1.6 and 3.1 million)...but on the other hand, it's also a good 800K lower than the 3.1 million they claimed for the better part of a year.

However, my concerns about the "Sub26ers" were allayed by Larry Levitt of the Kaiser Family Foundation, who stated (via Twitter) that:

"All these estimates have some uncertainty around them, but the 2.3 million figure for young adults is defensible...The under 26 provision had taken effect by 2013, so whatever the estimate is, it should be in addition."

In the end, I accepted the 2.3 million Sub26er figure after all.

That brings me to today:

A total of 17.6 million people have gained coverage under ObamaCare, according to a revised government estimate released Tuesday.

The newest figure, which is based on national survey data, shows that 1.2 million more people had signed up for healthcare over the last five years than previously thought.

The revised total includes 15.3 million people who gained coverage through the individual marketplace or through Medicaid. It also includes 2.3 million young adults who gained coverage because they were able to remain on a parent’s plan until they turn 26.

OK, so the 2.3 million chunk hasn't changed. Fair enough; that leaves 15.3 million via the ACA exchanges, Medicaid and the individual off-exchange market, up from 14.1 million:

Using updated data, ASPE now estimates that 17.6 million uninsured people have gained health insurance coverage. Coverage gains refer to different sources of coverage, including Medicaid, the Health Insurance Marketplace, and individual market coverage; therefore, gains are not limited to Marketplace-eligible individuals.

In other words, an increase of off-exchange individual enrollment IS INCLUDED here.

Unfortunately, the actual ASPE report doesn't break the 15.3 million out between the three categories, so I'll have to speculate, but here's my best guess:

Exchange-Based Private Policies:

OFF-Exchange Private Policies:

  • I honestly have no idea how many people--who were previously uninsured--enrolled in individual market policies directly through the insurance companies. I can't imagine there'd be too many of them, since off-exchange enrollment means paying full price (no tax credits or cost sharing reductions included). Perhaps 1 million at the outside?

Medicaid:

  • The June CMS Medicaid report specifies that total Medicaid enrollment had increased by 13.1 million people since October 2013 as of the end of June 2015...but not all of these peole are newly-insured, and a portion of them are "woodworkers" (ie, it's debatable whether they should "count" as being added to Medicaid "due to" the ACA since they were technically already eligible). My best estimate of the total number of new Medicaid enrollees who are eligible strictly due to the ACA expansion provisions is around 9.9 milllion.
  • If you assume that 90% of these new enrollees were previously uncovered, that's around 8.9 million.

SHOP:

  • As I've noted repeatedly, the ACA's Small Business Health Options Program (SHOP, though it should really be SBHOP which sounds stupid) has been a bit of a dud; only about 80,000 people enrolled in 2014 (when only a handful of SHOP exchanges were even working), and only around 200,000 people are enrolled via SHOP policies this year even with all 51 running full steam. I have no idea how many of these people are newly insured, but let's split the difference and call it 100K. It's a small enough number not to matter much either way.

Add them all up and you get 5.3 + 1 + 8.9 + 0.1 = 15.3 million people total.

As for the net 1.2 million overall increase since the March report, I'm assuming that a good million of that comes from Medicaid (again, the net strict-expansion portion of the Medicaid increase went up from 8.5 million to 9.5 million between February and June).