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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