The Mystery Obamacare Enrollment Number Has a New Estimate

A survey released Thursday gives insight into the number of exchange enrollees who were previously uninsured.

MIAMI, FL - OCTOBER 10: Deborah Eckhoff shows her support for the Affordable Care Act during a rally in front of the Stephen P. Clark Government Center on October 10, 2013 in Miami, Florida. The rally was held one week after the insurance marketplaces opened, with members of the OFA-FL volunteers helping people to understand that Obamacare, Affordable Care Act, is already working and to tell the Tea Party: 'Enough Already.' (Photo by Joe Raedle/Getty Images)
National Journal
Sophie Novack
June 19, 2014, 7 a.m.

We fi­nally have a num­ber for how many people who en­rolled in Obama­care ex­changes were pre­vi­ously un­in­sured: about 4.6 mil­lion.

Fifty-sev­en per­cent of the more than 8 mil­lion in­di­vidu­als who pur­chased private cov­er­age through the health law’s new in­sur­ance mar­ket­places were un­in­sured be­fore­hand, ac­cord­ing to a new sur­vey from the non­par­tis­an Kais­er Fam­ily Found­a­tion, re­leased Thursday. Most said they had been without cov­er­age for at least two years.

“There’s no ma­gic num­ber or tar­get, but it’s a much big­ger per­cent­age than crit­ics sug­ges­ted we’d see,” said Drew Alt­man, pres­id­ent and CEO of KFF. “Like everything with the ACA, the facts are some­where between what crit­ics and ad­voc­ates are say­ing.”

The Obama ad­min­is­tra­tion has touted its over­all en­roll­ment num­ber as evid­ence of suc­cess in the goal of re­du­cing the un­in­sured rate. But the law’s crit­ics and sup­port­ers alike have long wondered how many of those in­di­vidu­als are ac­tu­ally gain­ing cov­er­age, and how many simply switched from a dif­fer­ent in­sur­ance plan.

The new Kais­er find­ings af­firm what we already knew: that con­sid­er­ing all 8 mil­lion en­rollees “newly in­sured” be­cause of the health law is in­ac­cur­ate. Among non-group ex­change en­rollees, 16 per­cent say they were pre­vi­ously covered by a dif­fer­ent non-group plan; 14 per­cent say they were covered by an em­ploy­er/CO­BRA; and 9 per­cent say they were covered by Medi­caid or an­oth­er pub­lic pro­gram.

But the sur­vey also throws cold wa­ter on crit­ics’ as­ser­tions that very few en­rollees were pre­vi­ously un­in­sured.

“It may or may not be as large a per­cent­age as ad­voc­ates would like,” said Alt­man. “[But] for more than half [of en­rollees] to be pre­vi­ously un­in­sured, it shows cri­ti­cism was far from the mark.”

The find­ings are dif­fi­cult to meas­ure against any spe­cif­ic stand­ard, as the ad­min­is­tra­tion did not set a tar­get for per­cent­age of new en­rollees who were pre­vi­ously un­in­sured. The sur­vey also does not take in­to ac­count gains in em­ploy­er-sponsored in­sur­ance or Medi­caid ex­pan­sion.

The num­bers also come with the usu­al caveat that we still don’t know the num­ber of en­rollees who ac­tu­ally paid their first month’s premi­um and ended up with cov­er­age, points out Larry Levitt, seni­or vice pres­id­ent at the Kais­er Fam­ily Found­a­tion. Es­tim­ates from in­surers have ranged from 80 to 90 per­cent.

The sur­vey also ad­dresses two oth­er policy de­bates that have been yet-un­answered: health status of en­rollees and plan can­cel­la­tions.

The ma­jor­ity of en­rollees in ACA-com­pli­ant plans re­port be­ing in good health, though the per­cent­age is lower than in non­com­pli­ant plans. Sev­en­teen per­cent of those in com­pli­ant plans say they are in fair or poor health, com­pared with 6 per­cent in non­com­pli­ant plans. The skew­ing was to be ex­pec­ted, since the health law re­quires in­surers to cov­er all in­di­vidu­als, re­gard­less of health status.

Age has been used as a proxy for health in the past, but the sur­vey of­fers more con­crete in­sight in­to the met­rics that in­surers could use to set premi­um rates for next year. However, this will still de­pend on in­di­vidu­al in­surers; many likely an­ti­cip­ated the sick­er-than-av­er­age mix when they set their rates for this year.

Thursday’s sur­vey also found that con­cerns over “rate shock” for in­di­vidu­als with plan can­cel­la­tions were largely un­foun­ded. Those who switched plans due to can­cel­la­tion no­tices or oth­er reas­ons are more likely to say their premi­ums went down rather than up, and more likely to say their new plan cov­ers more ser­vices.

Over­all though, plan switch­ers — those with plan can­cel­la­tions in par­tic­u­lar — re­port less sat­is­fac­tion with cost and value of their plan com­pared with pre­vi­ously un­in­sured con­sumers in com­pli­ant plans.

The sur­vey was con­duc­ted April 3 to May 11, among a ran­dom sample of 742 adults ages 18 to 64. The mar­gin of er­ror is plus or minus 4 per­cent­age points.

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