Urban Institute: Uninsured down 5.4M since 2013 (Me: Tack another million or so on)

About 5 different people have sent me a link to this new study by the Urban Institute, which concludes that the total number of uninsured adults in the U.S. has been reduced by around 5. million people since last fall.

They're pretty clear about the time period: it runs from just before the exchanges launched until...well, actually, until early March (more on this below):

The Urban Institute's Health Reform Monitoring Survey (HRMS) has been tracking insurance coverage since the first quarter of 2013. Today, we report the first estimate of how the uninsurance rate has changed through early March 2014. These results track changes through most of the first Affordable Care Act's (ACA) open-enrollment period, which ended on March 31, 2014.

The results? According to this study, it's a net reduction of 5.4M uninsured:

Analysis of data from the March 2014 HRMS shows the uninsurance rate for nonelderly adults (age 18–64) was 15.2 percent for the nation, a drop of 2.7 percentage points since September 2013, the month before ACA open enrollment began. This represents a gain in coverage for about 5.4 million adults.

Don't get your hopes up too much; that this includes Medicaid as well, so it's not a simple matter of dividing 5.4M by 7.2M.

(Oh, and shocker (not): The Medicaid expansion states reduced their uninsured population by a lot more than the non-expansion states):

States that implemented the ACA's Medicaid expansion saw a larger decline: their uninsurance rates for adults dropped 4.0 percentage points since September, compared with a drop of 1.5 percentage points for the nonexpanding states. The average uninsurance rate for adults in the 24 nonexpanding states was 18.1 percent in March 2014, well above the 12.4 percent average in the expansion states.

As usual, the most interesting context is found in the footnotes:

These early estimates understate the full effects of the Affordable Care Act on the uninsured for two major reasons. First, the survey does not capture the enrollment surge that occurred at the end of the open enrollment period, because 80 percent of the responses to the March 2014 HRMS were provided by March 6, 2014. Second, these estimates do not reflect the effects of some important ACA provisions (such as the ability to keep dependents on health plans until age 26 and early state Medicaid expansions) that were implemented before 2013.

Hmmm...ok, this would be easier if all of the responses were from before March 7th, but the link is pretty clear that it's through "early" March. I'm going to assume that the remaining 20% came in during the second week. As it happens, the exchange QHP total happened to hit 5M right around the 16th (actually more like 5.1M).

So, this means that the final two million enrollees which signed up between 3/17 and 3/31 are not included in this study.

Considering that every source I've seen (even those opposed to the law) agrees that the uninsured percentage of QHP enrollees steadily grew every month (example: NY went from 50% in December, to 66% in early February, to over 70% in March), I'm pretty comfortable concluding that at least half of that "final" 2 million which came in during the last 2 weeks of March nationally were also uninsured, for a total of at least 6.4 million uninsured covered.

Even better, that doesn't include the new Medicaid enrollees from the last half of March (total number unknown), nor does it include any off-exchange QHPs from the latter part of March.

Seems to me we could be talking about a net reduction of easily 7-8 million or more here, but we'll have to wait until at least the March HHS and both the February and March CMS reports are in, I suppose...