Secretary of Health and Human Services Kathleen Sebelius
today announced that enrollment in the marketplaces created by Obamacare
has hit 7.5 million, with 400,000 people so far taking advantage of the extension
offered by the Obama administration to give folks more time to complete the process.
That's just the marketplaces — millions more have gained coverage via Medicaid expansion (including 150,000 and counting in Arkansas via the private option) and other features of the law, such as the provision allowing young adults to stay on their parents' plans. Two pieces of data released this week suggest that when you add it all up, Obamacare is making progress toward one of the core goals of the law: reducing the number of Americans without health insurance.
that the uninsured rate is now at 15.6 percent, the second straight quarter that it has fallen in the wake of the enactment of the Affordable Care Act
and the lowest that Gallup has measured since 2008 (see above). We should approach this figure with plenty of caution — surveys like this are imprecise and it's too early to know just how big the drop has been or whether the trend will continue. But it's a good sign that the law is moving the needle in the right direction.
The uninsured rate has been falling since the fourth quarter of 2013, after hitting an all-time high of 18.0% in the third quarter — a sign that the Affordable Care Act, commonly referred to as "Obamacare," appears to be accomplishing its goal of increasing the percentage of Americans with health insurance coverage. Even within this year's first quarter, the uninsured rate fell consistently, from 16.2% in January to 15.6% in February to 15.0% in March. And within March, the rate dropped more than a point, from 15.5% in the first half of the month to 14.5% in the second half — indicating that enrollment through the healthcare exchanges increased as the March 31 deadline approached.
And as the New Republic's Jonathan Cohn points out, Gallup jibes with other studies, such as a study released last week by the Urban Institute
which found the percentage of uninsured adults aged 19-64 fell from 17.6 percent in the first quarter of 2013 to 15.2 percent in the first quarter of 2014. Cohn zooms out
In short, it seems pretty clear that, because of Obamacare, more people have health insurance. And, yes, that accounts for people who lost existing coverage because insurers cancelled old policies. The question is how big a difference the law is making. And it's going to be a while before anybody knows.
The Gallup polll was released Monday. Then on Tuesday, the long-awaited (well, at least in health nerd circles) Rand survey was released
, which found a net gain of 9.3 million in the number of insured American adults between September 2013 and mid-March 2014. Again, we should proceed with caution here as there is a big margin of error but if this is close to accurate, it's a big, um, deal
: a 23 percent drop in the uninsured rate, from 20.5 percent to 15.8 percent. Oh, and note that this survey stops mid-March — these numbers don't account for the huge surge
in the final weeks and days of open enrollment — an additional 3.6 million people who signed up after the survey was concluded. The Rand study had some peculiar findings — in particular that the number of people with employer-sponsored insurance went way up, which no one was particularly expecting. Adriana McIntyre over at the Incidental Economist has a good take
on what that might mean in terms of Obamacare. Again, it's way too early to jump to any big conclusions about the law's impacts. But it's clear that more people are getting covered.
Here's Cohn again
Republicans and their supporters frequently say that 5 million people “lost” health insurance, because the old policies didn’t comply with Obamacare’s standards and/or insurers cancelled them pre-emptively. Sometimes Republicans and their supporters imply that these people actually ended up uninsured. But if Rand is right—and, again, there's no way to be sure right now—then it would appear most people who lost their old plans were able to get new ones instead. That's consistent with anecdotal reports from insurers.
You might remember in the heady days of healthcare.gov fiascos and Obamacare horror stories, opponents of the law claimed that because of the plan cancellations, Obamacare would actually lead to a net loss
in the number of people with insurance. U.S. House Speaker John Boehner
, as late as mid-March
: "that would indicate to me a net loss of people with health insurance. And I actually do believe that to be the case."
Nope. People are getting coverage. The number of people without insurance is falling. (Love this last-gasp headline from Fox News
And as Matthew Herper wrote for Forbes two months ago
, "For Republicans who want to repeal the Affordable Care Act, there is a major problem: many people may hate the law, but just as many like it. ... The point is that even with all the law’s problems, there may be a substantial number of people who come to depend on it before there is any political chance of repealing it — before the midterm elections."
Here's Paul Krugman
At least some Republicans are realizing that (a) the ACA is not going to collapse and (b) they can’t simply take away insurance from millions of Americans. So they have to come up with an alternative.
Those news-explaining kids at vox.com have more
And as Sahil Kapur reports, at least a few of them are coming to a terrible realization: there is no alternative. You can’t just support the popular pieces of reform, in particular coverage for preexisting conditions, and scrap the rest. As Jonathan Gruber taught me, and I and others have said many times, reform is a three-legged stool that requires community rating, the individual mandate, and subsidies; take away any leg and it collapses. And Kapur finds a GOP aide who admits to the awful truth: any workable GOP plan would look pretty much the same as Obamacare.
I don’t know how many GOP leaders, as opposed to aides, understand this. And even those who do won’t dare to admit it. The party line, literally, has been that Obamacare is an unworkable monstrosity, and the base will destroy anyone who points out, this late in the game, that it’s both workable and pretty much the only doable alternative to single-payer.
if you want to do a deeper dive into the numbers.
For the really big picture, I recommend enrollment guru Charle's Gaba's giant graph,
which looks at all the ways people have gained coverage under Obamacare, totaling between 14 to 34 million, depending on how you look at it (as Gaba explains, there are multiple ways one could do that count).