CDC says national uninsured rate down to of March. It could be as low as 8.8% today.

Today's the aniversary of my dad passing away. He was an Osteopathic physician, so today's Big News® would make him very happy, but I have to keep things short today so just a quick write-up:

The Centers for DIsease Control just released their latest big insurance coverage survey.

As I noted when CDC released the full-year 2014 NHIS back in June (which covered the full calendar year 2014):

The Centers for Disease Control has released their big National Health Insurance Survey, which confirms what every other study, survey and poll has: The Affordable Care Act did indeed caused the uninsured rate to plummet last year. On the one hand, this isn't exactly surprising news to anyone other than former U.S. Senator/NH Governor Judd Gregg and current U.S. Representative Gary Palmer, but whatever.

On the other hand, this particular survey carries more weight in some ways than the previous ones from Gallup, the Urban Institute, the RAND Corporation or the Commonwealth Fund, since a) it's the official government survey and b) the survey pool is massive.

The full 2014 annual survey was based on over 111,000 people. Today's report, which covers the first quarter of 2015, had a smaller pool size, but still an impressive one:

The data for this report are derived from the Family Core component of the 2010–2015 NHIS, which collects information on all family members in each household. Data analyses for the January–March 2015 NHIS were based on 26,121 persons in the Family Core.

There's a whole mess of data/statistics over time in the report, broken out every which way (by type of coverage, age bracket, etc), but the major notes of interest for me are:

  • The overall uninsured rate, including everyone, was down to just 9.2% of the total population, or around 29 million people.

Unlike Gallup and most other national surveys, the NHIS includes children under 18. This explains most of the discrepancy with, for instance, Gallup's 11.4% uninsured estimate as of the end of June; children have always had lower uninsured rates than the rest of the population to begin with, so when you include them in the total it definitely lowers the overall number.

Even so, this is a huge deal. My own number-crunching when the Gallup survey was released estimated that including children would drop the overall uninsured rate down to around 10.3%, or 33 million.

The NHIS results, however, have it even lower....9.2%, or around 29 million people.

  • This only runs through the end of March.

Obviously there are gonna be some differences in methodology, wording of the question and so on between NHIS and Gallup (along with the Urban Institute, RAND and so on), so this discrepancy isn't as big of a deal as it might seem. Even so, we can remove one of the major variables by going back to Gallup's first quarter survey and comparing. As of March 2015, Gallup had the uninsured rate among adults over 18 at 11.9%.

The implications of this are pretty significant:

  • For Q1 2015, Gallup = 11.9% for those over 18, NHIS = 9.2% for everyone.
  • For Q2 2015, Gallup = 11.4% for those over 18, NHIS = ???

A simple ratio comparison suggests that when the Q2 2015 NHIS report is released, it could have the total uninsured rate down to around 8.8% nationally, or just 27.8 million people or so.

So, what would account for a further reduction in the uninsured (of up to 1.2 million people) since the first quarter of the year? Well:

  • First, remember that about 214,000 additional people enrolled in ACA exchange policies after the NHIS study concluded, thanks to the special tax season enrollment period. Assume about 190K of these folks had their policies kick in on April 1 or May 1, after the end of the study.
  • Pennsylvania's ACA-expanded Medicaid program didn't start until the beginning of January, but it took a few months to actually ramp up due to some confusion over a different version of the program enacted by the prior Governor. While 439,000 people had signed up as of the end of July, only about 200K of them started during the NHIS period, so the additional 239K were added after that.
  • Similarly, Indiana's ACA-expanded Medicaid program didn't start until the beginning of February, and is up to about 290K now. Figure around 200K of those didn't start coverage until after March.

That's around 630,000 more people who started their ACA-enabled coverage after 3/31/15. Given the nature of these three subgroups, the vast majority of them were almost certainly previously uninsured. That's 0.2% out of 320 million people, easily accounting for knocking the uninsured rate down to 9.0%.

When you also throw in the improving economy/job market, it's easy to see how the uninsured rate could have dropped by even more than that thanks to increased employer-sponsored insurance.

Here's where things get even more eyebrow-raising:

Last month I estimated that these two subgroups made up around 31% of the total. However, assuming the NHIS numbers are more accurate than Gallup (and assuming both the 3.7M and 6.5M figures are accurate), it might actually be more like 35 - 37%, leaving just 17 - 19 million people who could still conceivably be left to get covered under ACA provisions.

Update: By an amazing coincidence, the IRS recently reported that about 7.5 million tax returns included a "shared responsibility" fee...aka the individual mandate tax for not having insurance coverage, out of a total of around 150 million federal returns. WIth 320 million people in the country total, that's roughly 2.1 people per tax return...or around 16 million uninsured people who paid the mandate fee, meaning they don't fall into the Medicaid Gap and aren't undocumented immigrants. The IRS also reported that around 15 million of those 150 million returns hadn't shown up yet, of which around 12 million had filed extensions and aren't due until October. If you assume around 1 million of those late filers also have to pay the fee, that's around 2 million more uninsured taxpayers who aren't in the Medicaid Gap...or around 18 million total.

Again, there's a lot of rounding off & estimating here, but overall it looks pretty solid to me.

Anyway, Jonathan Cohn of the Huffington Post and Peter Sullivan of The Hill have both written up good summaries of the findings; or you can check out the report itself for more.

Meanwhile, I have to take a trip out to visit my father's grave and give him the good news...