The consensus is 11M people. The Graph says 28.7M people. What the hey??

OK, I feel a bit silly posting this several days after HHS Sec. Burwell stated it officially, and it may seem especially anticlimactic given that I had already posted similar numbers from not one, not two, not three, not four, but five different respected national health insurance coverage surveys a couple of months ago (RAND Corp, Gallup, Urban Institute, Commonwealth Fund and the New England Journal of Medicine, to be precise), but it still seems like a good idea to lock this down for the record:

Taking questions yesterday from reporters for the first time at a White House news conference, HHS Secretary Sylvia Mathews Burwell said insurance programs created by the Patient Protection and Affordable Care Act have reduced the nation’s uninsured population by 26 percent. She called the reduction “the most important number” to measure the law’s success.

Of course, that 26% reduction statement comes immediately after the just-released Census Bureau survey from a week earlier which gave the 2013 uninsured rate--immediately before the ACA exchanges and Medicaid expansion took effect--as being roughly 42.34 million people.

So, some simple math: 26% out of 42.34 million is 11 million people.

So, how does this jibe with The Graph, which has the current grand total of people with ACA-enabled insurance coverage running at roughly 28.7 million people? I did a rough breakdown estimate back in June; here's an updated version with my modified estimates which explains the seemingly massive discrepancy:

ACA EXCHANGE ENROLLEES (8.1 million paid, 7.3 million current*)

  • 4.4 million (NEWLY-INSURED)
  • 2.9 million previously insured
  • 0.8 million moved onto other coverage*


  • 0.5 million (NEWLY-INSURED)
  • 7.5 million previously insured

MEDICAID ENROLLEES (9.3 million newly added)

  • 3.8 million Newly Eligible (NEWLY INSURED)
  • 1.2 million Newly Eligible (previously insured, likely paying through the nose or via "junk" policies)
  • 1.9 million woodworkers (NEWLY INSURED)
  • 1.1 million woodworkers (previously "insured" likely via "junk" policies)
  • 1.2 million previously insured (bulk transfers from various existing programs)

SUB-26ERS (up to 3.1 million...sort of)

  • Here's the thing...that "3.1 million" figure was already fuzzy at the time (several studies had it pegged as ranging as low as 1 million), and it was already 2 years out of date by the time the ACA exchanges kicked in last fall anyway.
  • There are numerous problems with trying to measure the "young adults on their parents plan" figure, not least of which is that the churn factor is enormous given the tight age range involved (19-25), as well as the fact that this was one of the first ACA provisions to kick in almost 4 years ago...which means that kids who were as young as 15 at the time have since moved into this range, while over half of those who started out in this age range (22-25) have since moved out of it. In addition, there's bound to be a lot of overlap between "being between 19-25" and "qualifying for Medicaid" and/or (to a lesser extent, unfortunately) "getting a job with ESI fresh out of college".
  • As such, this has always been the trickiest/most questionable data point to lock down. Therefore, whatever the breakdown may have been at an earlier point in the past year, I'm estimating that the current breakdown is more like:
  • 0.4 million (NEWLY INSURED or only CURRENTLY insured DUE TO the ACA)
  • 2.7 million previously insured or who would still have some other form of coverage even without the sub26 provision

SHOP/etc. (155K)

  • Negligible impact for 2014

In short, the "churn" factor as people move onto and off of various categories above means that many of the above figures are constantly changing. What if someone enrolled in an exchange QHP for 6 months, but then fell on hard times and now qualifies for Medicaid for the first time in their lives...either within the ACA expansion level, or within the "normal" Medicaid level? What if they were 64 and turn 65, moving onto Medicare? What if they were on Medicaid (at one level or the other) and then get a job with benefits, or one without benefits but which pays enough for them to get kicked off of Medicaid...but they now qualify for tax credits via an exchange QHP? What if they inherit a large sum of money and no longer qualify for Medicaid or tax credits, so they buy a new policy off-exchange?

You get the idea.