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After an expected surge of sign-ups in late December, just over 2.1 million people have purchased ACA-compliant health care policies through the federal and state health care exchanges. A bit more than half came through the now-mainly-functional healthcare.gov website (which covers 36 states) and the rest came from the 14 states which established their own exchanges. That relative disparity is due both to the early problems with the federal website and active efforts to sabotage enrollment in private insurance in Republican run states.
Next there are currently rough 4.3 million people who have been enrolled in Medicaid through Medicaid expansion. A 3.9 million number is still being used in many reports. But that's a number as of 11/30. Charles Gaba is compiling together publicly available reports from different states and currently has the number at 4.3 million - not a surprising number given how much sign-up activity there was in December. The state by state breaks in this spreadsheet are very illuminating.
Notably, we also know the number of Americans who have been prevented from getting coverage because Republican governors and/or state legislatures who refused to participate in Medicaid expansion. That's 5 million people.
So if the Supreme Court had decided differently or if most but not all (Kasich, Snyder, Brewer, et al.) Republican governors had not refused to participate we might be talking about a number in the neighborhood of 15 million newly covered people.
Next there's a number that's been in effect for a couple years now and no one seems to want to discuss: roughly 3.1 million young adults under the age of 26 who now remain covered under their parents policies under a key provision of the ACA. This went into effect in September 2010. And the number of covered young adults in that age bracket grew steadily over the next two years. Here's a good overview from Money magazine from June 2012.
So let's do some simple math. 2.1M + 4.3M + 3.1M = 9.5 million covered.
So how does it get to 10 million? What none of these tabulations take into account are people who bought ACA-compliant policies directly from insurance carriers as opposed to purchasing them from private carriers via the exchanges. A lot of people did this and there was actually an aggressive push to get people to do so while the federal exchange site remained basically dead in the water. There is no tally of this number yet and will require a survey of carriers throughout the country. But I suspect it is certainly in the hundreds of thousands. And thus the round number of 10 million.
Now, as I said up at the top, there are a lot of Obamacare dead-enders out there who just blow a gasket when they make first contact with these numbers. The first claim is that Medicaid expansion somehow doesn't count. Or it doesn't count if a 24 year old is now covered under their parents policy because well that happened a while ago or well, something.
The best dead-ender argument is that well, maybe these people who've signed up for subsidized private insurance policies won't end up paying their premiums. When the arguments get down to this level you know you're dealing with a deep and intense form of denial. I mean, what if all these people change their mind next month and decide they don't want the coverage after all? What if Obamacare is so bad they all die in the Spring? What if Spartacus had an airplane? If you really, really are hoping for bad news you can come up with anything to keep hope, as it were, alive.
And then finally, these numbers are just more administration lies. Because, well, because. Here's where Gaba's spreadsheet is so helpful. It has the breakdown for private insurance and Medicaid expansion in numbers in every state with a link to an independent news source reporting the numbers.
These are the numbers. Lots of people have partisan or ideological or in many cases deeply emotional needs not to believe them. But these are the numbers.