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How Many People Has Obamacare Really Insured?

How Many People Has Obamacare Really Insured? | Healthcare and Technology news | Scoop.it

One of the key questions surrounding Obamacare is just how many people have been newly insured under the law. The answer is clouded by the fact that the White House and others have changed some rules of math for making these assessments.


For example, several years ago, the Obama administration fiddled with the Census Bureau’s definition of what it means to be “uninsured.” The new parameters, which were looser than the old factors, make it hard to construct comparisons between today’s figures for the total number of uninsured and the historical trends.


The Obama team also abruptly started to exclude uninsured illegal immigrants from the national tally on total number of uninsured Americans. Before Obamacare, these individuals were counted in that reporting, inflating the numbers. After Obamacare, these individuals didn’t get insurance, but suddenly didn’t get counted any more.

Now, a new analysis from the highly regarded managed care analyst at Goldman Sachs, Matthew Borsch, and his team, cast uncertainty on some of the recent data releases from the White House, and its network of academicians. In particular, the Goldman breakdown conflicts in some key ways with a recent analysis from RAND that was published in the journal Health Affairs and widely cited by the media.

Goldman Sachs estimates that total coverage under the ACA increased by 13 to 14 million last year and may have increased by another 4 million during the first five months of 2015, for a total coverage increase of 17 to 18 million combined. At a top line, this coincides with the figure from RAND, which estimated that there were 22.8 million newly insured people since the launch of the ACA. At the same time, 5.9 million people lost coverage. This comes out to a net gain of 16.9 million lives.


But how the two reports arrived at their numbers differ in important ways. The Goldman analysis relied on multiple data streams, including information released by insurers. The RAND study used a survey instrument sent to 1,589 people.


There are two critical questions embedded in all of these analyses. First, how many of the newly insured people would have gotten health coverage anyway, through some other mechanism (like their workplace)? In other words, is the law simply crowding out other forms of private coverage? Second, how many of the newly insured simply ended up on an expanded (and decaying) Medicaid program? The answers to these questions are an important measure of the ACA’s “success.”


On the latter question, according to the Goldman analysis, about two-thirds of the 2014 coverage increase was from the expansion in Medicaid. For 2014, their figures for net new coverage includes 9 million more people obligated to Medicaid, and about 2 million aging into Medicare. Only about 3 million got commercial coverage.

Moreover, Goldman estimates that employer sponsored coverage declined by about 2 million lives last year, which is at odds with other estimates. The widely cited study by RAND, for example, estimated that 9.6 million people who became newly insured since the fall of 2013 gained their coverage by enrolling in employer sponsored insurance. At the same time, the Goldman analysis estimates that total individual, commercial coverage increased by about 5 million. People migrating out of employer-sponsored insurance, and onto the Obamacare exchanges, explain a large measure of the relative change, under the Goldman analysis. The biggest change, according to their data, was for small employers, where the number of covered lives declined by 2.2 million people, a reduction of 13% year-over-year.


This is in sharp contrast to other analyses, and particularly the RAND study published in Health Affairs, which found that an increase in employer-sponsored insurance was the biggest driver of the total rise in coverage. Moreover, RAND estimates that 43% of the people newly insured by workplace coverage had the insurance available to them in 2013, but opted not to take it. This would suggest that the new tax penalty compelled them to seek the coverage. The RAND authors noted that there were possible methodological challenges with their survey; including confusion people might have had about their own source of coverage. This could potentially explain the wide discrepancies between the two analyses.


Obamacare’s supporters have argued that the public exchanges have not crowded out private insurance coverage that was previously offered at work. The Goldman analysis suggests that the law has indeed crowded out some employer coverage.


Unanswered in all this is also the question of how many employers might have offered insurance for the first time, or expanded their coverage, but for Obamacare and the ability to move their workers onto the exchanges. In an expanding economy, the total share of employer-sponsored coverage should have similarly grown, if historical trends are any guide. Yet the number of people insured through work was flat by many other estimates, and according to the Goldman analysis, actually declined. This strongly suggests the ACA is displacing private coverage.


It could be that most of what Obamacare does to address the “uninsured” problem is obligate a whole lot more people to Medicaid, a program that already suffers from severe access problems owing to years of underfunding relative to its expanding mission, and the chronic health needs of its mostly indigent population. Obamacare only adds to the program’s strains. At the same time, on the commercial side, Obamacare may be mostly creating churn — by displacing people from their employer-sponsored coverage and moving them onto the exchanges.


It’s hard to know for certain, since the current figures – at least those released by Washington – can’t be compared to historical trends. The Census Bureau made a significant change in how it estimates the number of people who lack insurance, starting with its assessment for 2013. That means that after 2013, the results can’t be compared to those for prior years. The government’s new method conveniently results in a lower estimate of the total number of people without insurance.


So far, even if you accept the most optimistic math, Obamacare is hardly the unmitigated success that its many apostles proclaim. Whatever minimal gains in the level of commercial coverage that’s been achieved has come at a huge fiscal expense. This is not to mention the massive growth in costly and restrictive regulation.

These numbers will continue to be the subject of fierce scrutiny, dispute, and fiddling. The proclamations of those who worship the ACA as a new religion are carved out of these numerals. Their scripture is open to a lot of interpretation.

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U.S. government puts Obamacare enrollment at 6.8 million through Jan. 9

U.S. government puts Obamacare enrollment at 6.8 million through Jan. 9 | Healthcare and Technology news | Scoop.it

The Obama administration said on Wednesday that enrollment in 2015 private health insurance in the federal government's Obamacare insurance marketplaces reached 6.8 million people by Jan. 9.

The total includes 163,050 people who were enrolled during the week of Jan. 3 to Jan. 9. It also reflects people who selected plans or were automatically enrolled through the federal exchange, which serves 36 states. But the data does not include enrollment totals for exchanges operated by the remaining 14 states and the District of Columbia.

The three-month open enrollment period for 2015 began on Nov. 15, 2014, and will end next month on Feb. 15.


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U.S. deciding whether to extend Obamacare enrollment

U.S. deciding whether to extend Obamacare enrollment | Healthcare and Technology news | Scoop.it

Americans who have started enrolling for health insurance under the Affordable Care Act can still sign up, and the U.S. government is weighing whether to open a special enrollment period for those who missed Sunday's deadline, the health secretary said on Wednesday.

So far, 11.4 million Americans have enrolled in private health insurance through the health reform law known as Obamacare during the open enrollment period that ended on Sunday, according to the White House.

The Affordable Care Act requires most Americans to have health insurance or face a financial penalty. But some people may not realize they face a penalty for not having coverage until they file their tax returns in coming weeks.

 
 

HHS will decide within the next two weeks whether to allow another special enrollment period for consumers, Health and Human Services Secretary Sylvia Burwell told reporters in response to a question about those consumers amid the looming April 15 tax-filing deadline.

“We’re going to analyze it, we’re going to think about it, and we’ll be back. And we will be back quickly on it," she said at a news conference.

Separately, Burwell said fewer than 150,000 people were "in line" as of Sunday to get health insurance coverage through the marketplace set up by the Affordable Care Act. They will have until Feb. 22 to complete their application, she said.

Those applicants were in communication with the telephone call center for the federal exchange marketplace but could not complete their application before Sunday's deadline, according to HHS. They do not include people who had technical issues with the healthcare.gov website that prevented them from completing their enrollment, the department said.


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