START OF 2018 OPEN ENROLLMENT PERIOD

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20 Million.

While giving his big ACA speech in Milwaukee, Wisconsin a little while ago, President Obama mentioned a few key data points: 129 million people with pre-existing conditions being protected, 140 million people who were already insured having free preventative care added, etc etc.

He also dropped one really big new number: 20 million.

That's the net increase in the number of Americans who the HHS Dept. of the United States says have gained coverage (either via ACA exchange policies, Medicaid expansion or the ACA's provision requiring policies to allow young adults between 19 - 26 years old to say on their parents plans).

The official ASPE report breaks it out as follows:

  • This report estimates that 20.0 million uninsured adults have gained health insurance coverage because of the Affordable Care Act as of early 2016. This includes:
    • 17.7 million nonelderly adults (ages 18 to 64) who gained health insurance coverage from the start of Open Enrollment in October 2013 through early 2016.
    • 2.3 million young adults ages (ages 19 to 25) who gained health insurance coverage between the enactment of the Affordable Care Act in 2010 and the start of the initial Open Enrollment Period in October 2013 due to the ACA provision allowing young adults to remain on a parent’s plan until age 26.

The 17.7 million figure can be broken out roughly as follows:

I'll be honest...the "Sub26er" number gets a bit tricky for a number of reasons, partly because some policies already allowed them on their parent's plan prior to the ACA, and partly because of age changes over time (that is, someone who was 23-25 in 2010 obviously had turned older than 26 by 2013, thus was no longer allowed on their parent's plan and therefore had to be counted separately). However, the ASPE team appears to have already taken this into account in the report:

Uninsured Rates among Young Adults

Coverage gains for young adults (ages 19 to 25) started in 2010 with the ACA’s provision enabling them to stay on their parents’ plans until age 26. From the 2010 baseline periods through the start of Open Enrollment in October 2013, the uninsured rate for young adults declined from 34.1 percent to 26.7 percent, which translates to 2.3 million more young adults with coverage.

Our analysis of the Gallup-Healthways WBI shows that since October 2013, an additional 3.8 million young adults (ages 19 to 25) gained coverage, a 46.5 percent decrease in the number of uninsured young adults from that date. The adjusted Gallup-Healthways WBI uninsured rate for young adults fell by 12.1 percentage points, from 26.0 percent during the 2012-2013 baseline period to 13.9 percent as of early 2016. In total, an estimated 6.1 million young adults gained coverage from 2010 through early 2016.

In other words, about 2.3 million of those 6.1 million can be appropriately "counted" towards the net total number of people who've gained coverage.

They also break the numbers out in a bunch of other ways:

  • The uninsured rate for non-elderly adults (ages 18 to 64) declined by 43 percent between October 2013 and early 2016 (from 20.3 percent to 11.5 percent).
  • Coverage gains for nonelderly adults (ages 18 to 64) were broadly shared among racial and ethnic groups.
    • The uninsured rate among Black non-Hispanics dropped by 11.8 percentage points (a 52.7 percent decline) from 22.4 to 10.6 percent; corresponding to about 3 million Black nonelderly adults gaining coverage.
    • The uninsured rate among Hispanics dropped by 11.3 percentage points (a 27.0 percent decline) from 41.8 to 30.5 percent, corresponding to about 4 million Hispanic nonelderly adults gaining coverage.
    • The uninsured rate among White non-Hispanics dropped by 7.3 percentage points (a 50.7 percent decline) from 14.3 to 7.0 percent, corresponding to about 8.9 million White nonelderly adults gaining coverage.
  • There was a greater reduction in the uninsured rate among nonelderly adult (ages 18 to 64) women than among nonelderly adult men between October 2013 and early 2016. About 9.5 million women and 8.3 million men gained coverage.

Of course, there are a half-dozen different reputable firms which track the uninsured rate regularly out there, and each uses different criteria for doing so. Some only count adults over 18; others don't include those over 65; some ask whether the participant is currently insured, others ask whether they've been uninsured at any point over the past year, and so on. Different methodologies and pool sizes can give different results.

That's why one of the most important parts of today's ASPE report can be found on Page 6, where they've mushed together six of the most respected tracking surveys to show the overall trendline:

There are a number of estimates of the uninsured rate that are reported regularly. To put these new ASPE estimates in context, we report trends in the rate of uninsured from four other regularly reported survey efforts together with the Gallup-Healthways WBI (see Figure 4). Despite differences in sample size, response rate, and question wording, estimates from these surveys—the Gallup-Healthways WBI, adjusted estimates from the Gallup-Healthways WBI, the National Health Interview Survey (NHIS), the Urban Institute’s Health Reform Monitoring Survey (HRMS), the RAND Health Reform Opinion Survey (RAND), and the Commonwealth Fund Affordable Care Act Tracking Survey (CMWF)—all suggest large reductions in uninsured rates associated with the October 2013-March 2014 and November 2014-February 2015 Open Enrollment Periods. (Because HRMS, RAND, and CMWF do not sample in all quarters, some of the data points shown for these surveys are interpolated.) The unadjusted estimates, including those from Gallup Healthways WBI, are simply raw rates of being uninsured.

The bottom line is that any way you slice it, the ACA has dramatically reduced the ranks of the uninsured/uncovered over the past few years.

Yes, there are still serious issues with cost containment, carrier viability, premiums, deductibles, networks and so forth, and yes, there are still up to 30 million left to get covered...but this is still a pretty impressive accomplishment, and it's good to take a moment to recognize it.