Obamacare and the Uninsured, Redux
New survey data from Gallup is being hailed as confirmation that Obamacare is helping the uninsured get coverage.
It's essentially the same confirmation that we already had two months ago: The Gallup-Healthways Well-Being Index released today shows that the uninsured rate dropped to 13.4 percent this year, the lowest rate since the index was started in 2008. That's the same rate that Gallup found in April. The new survey data mostly confirms what we already knew, and suggests that coverage levels have flattened out. An additional survey from the Commonwealth Fund also estimates that about 9.5 million fewer people are uninsured following the law's coverage expansion, which is roughly in line with estimates from RAND and the Urban Institute.
As I noted in May when previous Gallup numbers were published, it's safe to say that Obamacare has reduced the number of uninsured. By how much, exactly, is hard to say, although most estimates seem to suggest a reduction of 9-10 million. As Politico notes, the precise drop is still difficult to determine, and the numbers are still fuzzy and even contradictory (RAND, for example, found that the bulk of the decline came from a big rise in employer-sponsored coverage, which is odd, and complicates the argument for the primary components of Obamacare's coverage expansion). But the overall effect is clear: Millions of previously uninsured people now have some form of health coverage.
In some sense, then, the health care debate has simply been reset to where it was in the years before Obamacare went fully live—before the exchanges launched so disastrously, before the sluggish early enrollment figures, and before the end-of-year wave of health plan cancellations. At that point, one thing that the large majority of observers, critics and supporters alike, agreed on, was that Obamacare would result in expanded health insurance coverage.
The debate was over broader questions that proceeded from that assumption: Does the coverage provide benefits commensurate with its cost? Will there be unintended consequences, like longer lines, higher premiums, and runaway costs to the government? Is Obamacare's complex multi-part coverage scheme the best, most efficient, most effective way to improve the nation's health system? Despite some of the triumphant declarations that the new reports prove Obamacare is working, Obamacare isn't necessarily a success simply because it managed to expand coverage; that's one test, but it's not the only one. It also matters how that expansion is achieved and maintained, and at what cost, with what further consequences.
Even the most precise coverage data won't resolve these sorts lingering questions. The debate over Obamacare will be with us for a long time to come.