Obamacare and the Uninsured



The Obama administration has said that it is not "systematically" tracking information on how many previously uninsured people have gained health coverage thanks to Obamacare. And a recent change in the way that the Census tracks coverage rates means that, when that data is eventually released, we won't be able to compare the new results to a multi-year baseline.

That means we have to rely on other sources of information. And for the moment, one of the best sources is Gallup's tracking poll. As I noted back in March, the survey has shown drops in the national uninsurance rate since the beginning of the year, when Obamacare's coverage expansion kicked in. When the drop first appeared early in the year, it was possible that it was just a result of month-to-month variation.

That's not really plausible anymore. The latest update shows that the uninsurance rate has continued to drop over the last few months, hitting 13.4 percent—its lowest rate since 2008.


After the botched launch of the exchanges last year, there was a lot of speculation—including from me!—about the possibility that, between the mass insurance cancellations caused by the law and the broken website, the law would actually result in a net loss of insurance coverage. That's pretty clearly not what happened. 

It's still possible that the data is not perfectly precise. We'll know more as some of the official estimates come out over the next year. And these sorts of dramatic gains may be harder to sustain in future years: Presumably the people who signed up first are those most motivated, or most easy to motivate, to get coverage. But at this point it's safe to say that Obamacare has helped reduce the ranks of the uninsured.

The survey does suggest some potential challenges for the health law going forward in terms of who is covered: It found increased coverage levels in all the under-65 age and ethnicity groups it measured, but the shift doesn't look quite as strong among Hispanics and young adults, two groups that were heavily targeted by the administration.

Gallup doesn't break out coverage by type, so we don't know how the newly covered are getting their insurance. Presumably, some proportion are getting covered through Medicaid. And the best evidence we have about Medicaid, specifically, is that it doesn't do much to improve measurable physical health. It's basically a financial shock absorber.

Of course, as I noted with regards to the study I wrote about earlier today, which found a reduction in mortality in Massachusetts following the implementation of RomneyCare's coverage expansion, it's always helpful to compare any of these gains against their likely costs. Obamacare requires about $2 trillion in spending over the next decade. And, yes, that spending is supposed to be offset by a combination of tax hikes and reductions to Medicare spending, but even still, that's $2 trillion that won't be spent on something—or many somethings—else. Making policy choices is about more than finding a positive result and declaring success; it's about comparing the results and the costs with the forgone opportunities.