Where Does Obamacare Stand?


Yesterday we learned that a big surge of sign-ups at Healthcare.gov in the last days of December pushed the number of enrollees through the federal exchange to more than 1.1 million. That’s a big number. But it’s still small when you consider the number of people who lack insurance in the country and small compared to the targets set for sign ups by the end of the year.

But it’s not the whole picture.

As noted, more than 1.1 million people have signed up via the federal exchange site. But that doesn’t include people who’ve enrolled through the 14 state exchange sites which have generally done a better job (especially in October and November) signing people up. One person collecting this data is Charles Gaba. He’s maintaining an incredibly helpful data set compiling the enrollments released in dribs and drabs from these 14 states. That number currently stands at just under 1 million enrollees. That puts the total number of enrollees at probably a bit under 2.1 million.

That’s substantially short of what was reportedly the administration goal of 3.3 million sign ups by the close of 2013. But it’s not wildly shy of the number. And one could reasonably argue that it’s a decent recovery given the fact that 2 of the 3 months the system has been open were essentially lost.

But it’s not just that. As Ezra Klein pointed out back in late November, these ‘targets’ (3.3 million by the close of 2013 and 7 million by the end of March 2014) began as estimated enrollment numbers compiled by the Congressional Budget Office. They evolved into the benchmarks the administration itself used for planning purposes. And in the politically contentious environment surrounding Obamacare, they further evolved into a sort of litmus test of whether the program was succeeding or failing.

But there’s actually nothing magic about hitting those numbers on those specific dates.

As a political matter, ACA supporters have to live with them. But as a substantive matter, it’s important to recognize that they do not count as any meaningful metric of success or failure. They’re just a prediction based on the rolling out going reasonably well – something that obviously did not happen.

What are the other relevant numbers?

According to Gaba (and this is consistent with other estimates I’ve seen) just over 4 million people have gained coverage via Medicaid expansion (which is obviously skewed greatly by the geography of which states did and didn’t opt in). That brings the new people with care to just over 6 million. Gaba also notes this June 2012 piece in Money, which notes that 3.1 million young adults had gained coverage under the part of Obamacare which requires children be allowed to stay on their parents plans until their 26th birthday.

Add all these up and you get a number between 9 and 10 million people who now have health care coverage because of the Affordable Care Act.

It would be interesting to tabulate the number of people who currently do not have coverage because individual states decided not to opt into Medicaid expansion. This is based on pretty basic and readily available demographic data. So it would not be too difficult for someone with a little experience to put that number together. In fact, I imagine someone’s probably already done it. If you’ve seen it, let me know. (Late Update: The number is 5 million people.)

One other question I have is what about people who got fed up with healthcare.gov and ended up getting an ACA compliant policy directly from an insurer. I thought about this when I heard again from TPM Reader LB

I wonder how many of me there are? I am 58, with a pre-existing condition and a tenuous grip healthcare with an extremely expensive small group policy. It isn’t hyperbole for me to say that passing and sustaining obamacare has been my first thought every morning and my last prayer every night.

I tried to sign up at 12:01 on Oct 1st (you know how that went) and kept trying until early December… We don’t qualify for a subsidy, so I went through the website solely to stand up and be counted. Finally, I gave up, used the healthsherpa site to find the plans, and contacted my insurer of choice directly,

My husband ( he’s younger and healthy) and I purchased wonderful Obamacare plans for approximately 1k less that we pay now. I am over the moon happy… And cannot begin to describe the relief…

My only sadness is that I want to be in that number (yup, I’m from NOLA) . People like me ( and my better demographic husband) owe so much to this president and this law….

Shouldn’t there be a way to count how many new 2014 individual plans insurance companies sold outside of the websites? I promise you my story is not unique…

I’m curious what this number is too. I doubt it makes a big dent in the global numbers. But it’s probably not a trivial number either.

One key thing any health care policy economist will tell you is that the pure numbers are less important than the demographic blend of the pool. Basically, what’s the mix of young and old people, healthy and sick. If that’s significantly out of whack you’ll have problems. All told, though, if you step away from the political pyrotechnics where every missed target is a catastrophe for Obamacare and the end of the Obamacare presidency, the current numbers look like a decent recovery from a very poor start. And there’s good reason to think that the program as a whole is moving along toward the benign and effective transformation of national health care markets it was intended to affect.