Finally, we have real ObamaCare enrollment figures. The Census Bureau has released its definitive data on the number of uninsured in 2014 from talking to real people.
The population-wide uninsured rate fell from 14.5% in 2013 to 11.75% in 2014. The total number of uninsured fell from 45.2 million in 2013 to 36.7 million in 2014 – a net of 8.5 million Americans who gained coverage.
Chris Conover, writing in Forbes, tells us there are two important points to note about this new number:
- The actual gain in coverage – 8.5 million – is well below previously released estimates of the reduction in the number of uninsured achieved in 2014.
- It also is well below official government projections of how many uninsured would gain coverage under ObamaCare.
Previous estimates have been put out by the Urban Institute, RAND Corporation, Commonwealth Fund, Gallup, and the CDC’s National Health Interview Survey (NHIS). These estimates for gains in coverage have ranged from 9.5 million (Commonwealth) to 10.6 million (Urban Institute) to 12 million (Gallup). ObamaCare Facts even claimed 15 million newly insured.
Why are the results released by the Census Bureau more accurate?
The Census Bureau results come from the American Community Survey (ACS), which is based on a survey of approximately 3.5 million households (about 8.8 million people). In contrast, the NHIS surveys only 87,500 people and all the other surveys focus exclusively on adults, therefore they cannot provide an accurate population-wide estimate of the number of newly insured. The numbers of these private surveys are all significantly smaller; Gallup (44,000 adults), Urban Institute (7,500 non-elderly adults, Commonwealth (6,200 non-elderly adults) and RAND (2,500 non-elderly adults).
Previous Government Projections
Shortly after the passage of ObamaCare in 2010, the Medicare actuary (CMS) predicted the number of uninsured would decline by 23.8 million in the first year! The Congressional Budget Office (CBO) was more cautious, projecting a reduction in the number of uninsured of 18 million between 2013 and 2014 alone.
After the Supreme Court struck down the mandate to expand Medicaid, the CBO became more pessimistic. The CBO estimated that the 2014 reduction in the number of uninsured would be only 12 million; and then to 11 million after the chaotic rollout of the new law in October 2013; and then to 10 million by the end of the open enrollment in March, 2014.
Yet, despite these significantly reduced expectations, ObamaCare enrollment has still missed the mark by 15 %. Conover believes the fairest grading standard is the May 2013 projection because it was uncontaminated by observing the actual abysmal performance of the exchanges in the first few months of open enrollment. By that standard, the CBO missed their projections by 29%.
Despite these much poorer enrollment numbers, President Obama continues to declare, “ObamaCare is working not just as intended, but better than intended.” Conover remarks that achieving 71% of a target may constitute “better than intended performance” for a community organizer. But can you imagine any other line of work where that would be considered acceptable?
Future Projections More Unrealistic
Conover believes 2014 may represent the best performance we will see in government projections. The future could be worse. The latest CBO projections show that by 2016, the net reduction in uninsured is expected to have climbed to 23 million. He believes even the most wild-eyed optimist couldn’t foresee that possibility.
The optimistic projections of Charles Gaba at ACASignups declare paid enrollments on the Exchanges in 2015 will be only 77% higher than they were in 2014 (rising from 5.46 million to 9.67 million). His figures for Medicaid expansion show a gross enrollment increase of 10.2 million in 2014, but only 3.8 million in August 2015. Even if you optimistically assume the latter figure equals 2/3 of the gross enrollment by the end of 2015, that means total Medicaid enrollment will have expanded only 55% in 2015 relative to 2014.
Even with these optimistic numbers, we’ll only see an additional reduction in the number of uninsured by 5.3 million. Furthermore, this doesn’t take into account that the lion’s share of reduction of the uninsured has come from Medicaid, rather than from the Exchanges.
Conover summarizes his findings: “In short, we will have missed CBO’s target by nearly 6 million instead of only 3.5 million last year. And even that may be optimistic in that it ignores the fact that 2014 and 2015 essentially would have captured nearly all the low-hanging fruit. In each subsequent year, it’s gong to be harder and harder both to find and persuade the remaining uninsured to obtain coverage.”
Why are these numbers important?
Lower enrollment numbers mean fewer people have health insurance. Lower enrollment numbers mean higher prices for everyone enrolled. Moreover, prices will be rising even if the enrollment numbers were good! University of Minnesota finance professor Stephen Parente has shown that by late 2016, Exchange premiums are likely to have increased 45% for the most popular Bronze family plans (more than double this for individuals). As a result, the number of uninsured is expected to gradually rise instead of decline in 2017.
If that happens, as Conover expects, the impact on the 2016 election should be as dramatic as it was on the 2014 mid-term elections when Republicans regained control of both houses of Congress. Wise Republican presidential candidates won’t miss the opportunity to hammer home this message to the voters.