Vindication: LA Times / Rand Corp.: 9M Off-Exchange Enrollments

At least 5 different people have sent me the link to the following story from yesterday's LA Times. Here's the key passage:

Precise figures on national health coverage will not be available for months. But available data indicate:

• At least 6 million people have signed up for health coverage on the new marketplaces, about one-third of whom were previously uninsured.

• A February survey by consulting firm McKinsey & Co. found 27% of new enrollees were previously uninsured, but newer survey data from the nonprofit Rand Corp. and reports from marketplace officials in several states suggest that share increased in March.

• At least 4.5 million previously uninsured adults have signed up for state Medicaid programs, according to Rand's unpublished survey data, which were shared with The Times. That tracks with estimates from Avalere Health, a consulting firm that is closely following the law's implementation.

• An additional 3 million young adults have gained coverage in recent years through a provision of the law that enables dependent children to remain on their parents' health plans until they turn 26, according to national health insurance surveys from the federal Centers for Disease Control and Prevention.

• About 9 million people have bought health plans directly from insurers, instead of using the marketplaces, Rand found. The vast majority of these people were previously insured.

• Fewer than a million people who had health plans in 2013 are now uninsured because their plans were canceled for not meeting new standards set by the law, the Rand survey indicates.

I'll have more to say about this later, but for the moment:

  • The "1/3 previously uninsured" in this case specifically refers to only the exchange-based QHPs. However, it still doesn't include the additional million people who I estimate have (and still are!) enrolled over the past 4 days and today. If 2/3 of these are currently uninsured, that could bring the final "previously uninsured" portion of the 7M exchange QHPs up to as high as 40%.
  • The "at least 4.5M" added to Medicaid doesn't just track closely with Avalere Health, it also tracks very closely with my "Strict Expansion" number (currently at 4.7M, plus another 1.8M estimated "woodworkers")
  • Here's the big one: "About 9 MILLION" off-exchange enrollments.

People have been very skeptical of my "4 million +" estimate of additional off-exchange enrollments (actually, 4.56M + since that didn't include the 560K that I've already documented). Most seemed to think that the real number was lower.

I don't understand why they thought this--the 560K I've documented came from only 2 states (WA & WI), plus a dozen companies scattered across the other 47 (Vermont & DC don't allow off-exchange enrollments for individuals).

I've said repeatedly that the 4M number is a minimum, that the real number could be 5M, 8M, 10M...I had no idea. I just knew it was a LOT of people.

As I noted in my Washington State entry from February 20th:

More significantly, however, compare the off-exchange enrollments with WA's exchange-based ones: Almost 2.2x as many people.

Think about this for a minute. IF Washington State is in any way representative of the rest of the country--and I have no idea whether it is or not--that suggests that the total number of "Off-Exchange"/Direct enrollments in ACA-compliant healthcare policies could be as high as 7.7 Million nationally (up to 2.2x the 3.5 million exchange-based enrollments reported to date).

...Now, I seriously doubt it's that high; I never imagined it would be any higher than 2-3 million or so, possibly equalling the exchange-based number at most. Regardless, we're definitely talking about at least a few million people.

Well, it turns out it is that high...and even higher yet.

Certainly a lot more than Megan McArdle or Avik Roy thought, anyway.