Obamacare Covers the Uninsured (and Some Who Weren't)



The headline news from last week's Kaiser Family Foundation survey of people who enrolled in individual market health insurance was that more than half—57 percent—of those enrolled in coverage through Obamacare's exchanges were previously uninsured.

That's a marked improvement over previous outside surveys from McKinsey and RAND, which found that 24 percent and 36 percent of Obamacare-era enrollees were previously uninsured. The surveys were taken at different times, and they used different questions and different methodologies, which almost certainly accounts for some of the variation. But because the Kaiser report is the most recent, and because it relies on a randomized survey sample, it's likely to be taken as the closest thing we have to a canonical number, at least for now.

Kaiser estimate represents a significant improvement over the previous estimates produced by McKinsey and RAND, and in that sense it represents good news for the health law's supporters. Certainly, they will now be able to say that a majority of the people covered through the law's exchanges were previously uninsured.

But even still, the survey results suggest the potential limitations of Obamacare's coverage scheme.It's not a precise instrument: More than 40 percent of exchange enrollees were already insured, suggesting that while Obamacare is expanding coverage to the uninsured, it's also resulting in a fair amount of subsidized coverage going to people who already had coverage (the vast majority of exchange beneficiaries got subsidies).

Digging a bit deeper into the survey also hints at the difficulty in measuring who, exactly, counts as previously uninsured. If someone had health insurance up until a month prior to getting new coverage under the law, should that person count as uninsured? Probably not. What about six months before? Or a year before? These questions are legitimately difficult to answer.

Kaiser's survey finds that the majority of previously uninsured lacked coverage for two years, and that 45 percent reported not having coverage for five years. Which means that more than half of the previously uninsured were covered at some relatively recent point.

Now, many of those people clearly were having difficulty getting coverage for some reason—perhaps as a ripple effect of the recession, perhaps because of some other factor. But many of them appear not to be completely uninsurable. These are not people who couldn never get insurance under any circumstance. They're people who didn't have it for the last several years.  

Obamacare's supporters would no doubt say that the law was designed to help those people just as much as it was designed to help those who never had coverage at all. That's an entirely reasonable position. But when we talk about Obamacare's coverage effects, it's important to be clear about who is being covered: a sizable number of people who were already insured, as well as people who were both eligible for coverage and covered at one point, but had lost their coverage.

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  1. The percent of uninsured question (on page 6 of the kaiser survey) asks “AMONG NON-GROUP ENROLLEES WITH ACA-COMPLIANT PLANS: Percent who say before they began purchasing their current plan, they were”
    a) Uninsured
    b) Covered by a different non-group plan
    c) Covered by an employer/COBRA
    d) Covered by Medicaid/other public program

    57% of exchange participants answered unisured. Which I think is probably true, but I would have liked to see an additional question. How many were uninsured on December 31, 2013? The exchange launch was a disaster, most insurance was bought in 2014, most plans ended 12/31/2013, depending on how people interpreted the question (were they insured last year or were they insured right now) it would have a different answer. I would have liked to see a question that hit both, as it would have highlighted the number of people with a gap in coverage due to obamacare.


    1. Just like my dad told me recently (he was a CEO of a hospital for many years), the ACA would actually result in more people being uninsured with even higher costs.

      The federal government has done nothing but increase the cost of healthcare while ensuring shittier outcomes. Thanks a real lot for that!


        1. Only if he has his card.

  3. The relative insignificance of the ACA is starting to dawn on the public. It was never a “federal takeover of 18% of the economy” like the wingnecks said it was.


    1. And yet everybody seems to be experiencing double digit rate increases and skyrocketing deductibles.

      Instead of a “federal takeover of 18% of the economy” it’s looking to simply be a law that materially harms a majority of Americans.

      I still can’t figure out where all the money is going.

      1. The money was destroyed. The economy runs on efficiency, that is how there is (real) economic growth. If the govt gets involved (or more involved), there is less efficiency. Therefore, stuff gets more expensive and NO-ONE BENEFITS!

        Your dollar now goes less far. Congrats…

      2. Where else would the money be going? Waste, graft, corruption, cronies, waste, and waste. Like it always does with anything the government touches.

        1. Where else would the money be going? Waste, graft, corruption, cronies, waste, and waste. Like it always does with anything the government touches.

          And yet they’ll still use the skyrocketing cost of healthcare as a reason to fully socialize the system and institute single payer.

          Somehow people who saw their health care costs triple with this level of government involvement will agree that further increasing such involvement is the only way to keep the costs down.

    2. Am I free to forego purchasing health insurance now? Can I purchase catastrophic only plans?

      1. It seems like most plans are becoming de facto catastrophic only plans, since deductibles have risen so dramatically.

        Sure your coverage includes everything now, but you have to spend a few thousand dollars of your own money before you can actually use your insurance.

        If this happened on its own it might very well be a good thing, because it would force health care providers to compete on price. Unfortunately however, so much waste has been introduced into the system by the ACA that providers can’t afford to lower their prices.

        As a result, the majority of Americans get an inferior product as a much inflated price.

        1. Sixteen thousand dollars a year for a plan with an eight thousand dollar deductible. It’s utterly ridiculous.

        2. As John points out repeatedly, the upshot won’t merely be rising prices for consumers, it’s also going to mean more consumers simply stiff doctors for whatever their insurance fails to cover. And doctors, too, will begin refusing patients with certain forms of coverage.

          Apologists like shriek can insist the ACA is a market-friendly “reform,” right up until the bottom falls out, but in reality no price-setting policy will ever fail to wreak catastrophic damage to the industry it’s meant to shore up.

        3. Yes, exactly, these are catastrophic plans at regular prices. When I say regular, I mean that for maybe $500 monthly, you are getting virtually nothing until you have something catastrophic happen. And in that case, who has another $6k to pay for the deductible? Wasn’t avoiding bankruptcy one of the left’s narratives for the ACA?

          The real beneficiaries of the ACA are the people who get their coverage for virtually free: Obama’s welfare crew. Perhaps this was the goal of this entitlement all along, to create a new dependency constituency while pretending that everyone is helped by it.

  4. Lessee here, most optimistic possible result is that 57% of the 8mm enrollees were “previously uninsured”. That comes to, call it, 5mm people. I’ve got a few questions that perhaps someone who is willing to wade through this survey can answer:

    (1) What is the definition of “previously uninsured”? Does it catch people whose policies were cancelled at the end of 2013? Why would we count someone whose policy was cancelled because of OCare as someone who obtained insurance because of OCare?

    Remember, the estimate was that @ 5mm people lost coverage because of OCare mandates. I would think those people would be first in line at the exchanges.

    Assuming none of the “previously uninsured” are people who lost insurance because of OCare, doesn’t this mean we’ve basically broken even? @ 5mm lost insurance, @ 5mm gained insurance?

    (2) Does this survey account for who has actually paid their first premium, or are they going off of the Obama definition of “enrolled”, which most people would regard as “applied for insurance”?

    Let’s say it doesn’t (which I think is likely, because of the timing and the administration’s refusal to gather this data). As I recall, the estimates were that something like 25% of HIE “enrollees” wouldn’t pay their first premium. That’s knocks the best-case number down to 57% of 6mm, or 3.5mm new enrollees.

    1. You’re just like the wingnecks and peanut gallery.


    2. There is also a percent of people who were uninsured who were going to get insured anyway. There is a good amount of natural churn. Sixty something percent of people who were uninsured before the law were insured within a years time. So I wish we had an estimate on that part too.

  5. But because the Kaiser report is the most recent, and because it relies on a randomized survey sample, it’s likely to be taken as the closest thing we have to a canonical number

    Because apparently no numbers are forthcoming from HHS.

  6. This is a free market plan that is actually the Republican plan. If Republicans hate it so much, where is their replacement? Why did they refuse to compromise with the Democrats and Obama? Yeah, a few plans were cancelled, but that’s because they were inadequate and only the government could fix the problem. Obamacare is the law of the land and was upheld by the SCOTUS. Elections have consequences

    I think that touches on all the ridiculous arguments I’ve personally heard from the supporters.

    1. Making underwriting illegal, crushing health savings accounts, and mandating what insutrance covers and how they opperate their business was never the “republican plan.”

      All this does is drive costs up and makes future imporvments more difficult all for a modest and relativily temporary coverage expansion.

      Nothing was done to make actual healthcare less expensive (in fact it did the opposite). All this did was turn insurance into a socialized cost scheme.

    2. Oh great, a new Media Matters talking-points troll. Government created the health insurance problem, fool, and this does not “fix” it.

    3. This is a lovely argument you have there. You do realize that a good portion of us, including many who regularly vote Republican, are at heart libertarians. This means that just because Mitt Romney supported a version of ObamaCare, doesn’t mean that the rest of us will automatically support it.

      Indeed, what has been happening in Massachusetts is a microcosm of what we can expect from ObamaCare, and it’s bad news.

      But you seem to support it because it’s put in place by Democrats, and that should be good enough for us!

      AS for potential reforms, here’s a couple: decouple insurance from employment–I should be free to buy my own health insurance, on my terms, without having to worry that I’ll immediately lose it because I lose my job. Also, let’s legalize buying plans across State lines.

      There are many more reforms that can be proposed, and a lot of them are simply insisting that Government get out of the way, a handful involve expanding already-existing programs, and all of them involve leaving the rest of us alone.

  7. Its astonishing to me how much you have gotten wrong, Peter, on the ACA.

    More uninsured have taken part than you predicted, and sadly for you that number will only get better, due to one simple fact. The penalty for the first year for an uninsured, young, healthy person was miniscule. It only goes up, and that will drive more into the exchanges (and yes there are enough enrolled now to make it successful, another prediction you got wrong). And yes, that will drive prices lower.

    And even more insurers are now joining in, which will keep prices lower than expected (by you).

    “A growing number of insurers say they intend to offer coverage on the ObamaCare exchanges next year. Insurance plans in New Hampshire, Michigan and Illinois are planning to enter into the federal marketplaces after deciding not to participate during ObamaCare’s first enrollment period, according to news reports. In New Hampshire, the number of ObamaCare insurers is set to rise from one to five next year; from 13 to 18 in Michigan; and from six to 10 in Illinois.”


    1. And yes, that will drive prices lower.

      Haha, no. Prices will still rise, along with taxpayer subsidies.

      1. Indeed they do.

        Its the rate of increase that is being slowed. By the way, Oregon actually did suggest that prices will be lowered.

  8. Kaiser Permanente is hardly an impartial source. If it were up to them, they would be running the national health service

  9. I pay $23/month for health insurance with NO deductible (everything is free). I am 74 years old and live in Mexico. How on earth can this 2nd world govt here provide such reasonably good care for so little money?

    One clue: there are lots of doctors here–supply & demand sets the costs. One private clinic chain charges $2.30 per visit–“Doctor Simi Clinics”.

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