New Study of Obamacare Coverage Suggests What the Health Law Is—and Maybe Isn't—Doing



Yesterday afternoon, the RAND Corporation published the first study following Obamacare's second open enrollment period to examine recent changes in U.S. health coverage. Like RAND's similar study from last year, it's a bit of puzzle, but an interesting and perhaps revealing one: It tells us quite clearly what's been apparent for quite a while now, which is that millions of people have gained health insurance following Obamacare's coverage expansion. But it also suggests the complexity and difficulty of determining exactly how those coverage gains have been achieved, and how much of the gain is directly tied to Obamacare.

The headline figure is that, on net, 16.9 million people have gained insurance between September 2013 and February 2015—with 22.8 million newly insured and 5.9 million having lost coverage during that time frame. But the vast majority of newly covered, according to the study, gained insurance through employer-sponsored plans rather than through the exchanges or Medicaid, Obamacare's primary coverage vehicles.

Changes in employer coverage practices as a result of the health law are probably part of the story, but job gains coming out of the recession are almost certainly part of it too. In other words, even with RAND's coverage breakdown, it's hard to pin down how much was a direct result of Obamacare, and how much was about the relative revival of the economy.

The study also suggests that exchanges may be mostly serving people who were previously covered. Of the 16.9 million people the study says gained coverage, on net, RAND's report finds that 4.1 million got coverage through the exchanges. That's only a fraction of the 11.2 million people the study estimates are covered through the exchanges; the other 7.1 million, the study says are people "who transitioned to marketplace plans from another source of coverage." Another study, however, found that more than half of exchange enrollees are newly insured.

RAND's study is useful and interesting, especially given its detailed breakdown of coverage types, but it also has a number of limitations: In particular, the study relied on a survey, which means that people may have incorrectly identified their insurance, and a fairly small sample size—just 1,589 "observations"—with a low response rate: just 9 percent. So while it provides a potential sketch as to what's happening, it's not the world's most precise measure.

NEXT: Court Says PATRIOT Act Doesn't Allow Mass Data Collection, Media Censored as Brits Vote, New York Allows Bitcoin Exchange: P.M. Links

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. the RAND Corportation

    In conjunction with the saucer people and reverse vampires?

    1. Looks like Rand Paul’s super PAC is trying to tarnish Obamacare(s).


    2. I don’t know what that organization is or what they do, but I love the idea of what their name does to progressives. First, they probably picture Rand Paul, then Ayn Rand, then they get hit with “corporation” just to top it off. It’s two or three things they hate all crammed into one name!

  2. In other words, even with RAND’s coverage breakdown, it’s hard to pin down how much was a direct result of Obamacare, and how much was about the relative revival of the economy.

    Hey, if you can’t zero in on how many insurance policies have been created or saved by Obama fixing healthcare because Obama fixed the economy, that’s not Obama’s fault.

  3. Let’s see here:

    Medicaid doesn’t count. Its not insurance, its welfare. So subtract the 9.6mm added to the welfare rolls. That’s more than half of the net increase, bringing it down to 7.3mm. Note that Medicaid almost doubled under Obama. Woot.

    “Non-Group” and “Other” showed losses of 11.9mm. These are the markets that were supposed to shift to the Exchanges iniitally, which increased by 11.2mm, for a net loss in the non-employer marketplace of .7mm. Some of these may have gotten insurance through their employers. Not looking like any kind of win in the non-employer marketplace, is it?

    Employers are up 8mm. Considering job growth of just over 5mm from January 2013 through December 2014, an increase in 8mm people covered through their employers looks very lackluster. I would say pure job growth probably accounts for all the increase on the employer side.

    One that puzzles me is that I’m not sure how Rand accounts for population growth in this thing. The population of the US increased by around 6mm in 2013 and 2014 (a guess on my part), then how does that affect their numbers?

    Bottom line: it looks like OCare has had zero effect on the actual insurance market, with changes there being attributable to job growth, period.

    1. Bottom line: Obamacare would have been great if not for your obstructionists, but you wouldn’t clap for Tinkerbell, and now she’s dead. Next stop: Single Payer! ChooChoo!

        1. health care for all, wa?

          1. I read it as, “Health care for all, waaaaaaaaaa!”

            1. It should be “health care for all… HAAAAAA!”

        2. Make a counter-proposal:

          “Canadian health care is much cheaper AND has better outcomes – why not just arrange to send patients to Canada? We pay a bit more and everything works out for everyone”

          1. We could wave to each other’s patients as we cross the border since we’re already taking theirs.

            1. Shhh, you’re not supposed to mention that.

              Lower Cost! Better Outcomes!!! SINGLE PAYER FOR ALL!!!!

          2. AND has better outcomes

            It does?

            All of the investigating I’ve done on single payer systems shows they have markedly worse outcomes, except for infant mortality (which is really just accounting magic, if you can call leaving babies to die that otherwise might have lived [had they been born the US] “magic”).

            1. Should have added a /sarcasm tag I guess….

    2. Zero effect?

      My individual plan – pre-Obamacare – ran me $110/mo. with a $3,500 deductible. After Obamacare, that same plan shifted to $340/mo. with a 5,000 deductible. Yep, that’s zero effect.

      When the shift was imminent, I got a letter stating I could keep my plan, keep my doctor if a number of criteria was met, one of which was at least one new enrollee in my plan each month thereafter. But…. buried in the details was that the plan was no longer able to be offered under the new law. So much for that one new enrollee. Yep, zero effect.

      The real kicker, though, is how that shift took place. Not wanting to see a decline in numbers, this brilliant administration encouraged insurers to automatically enroll us into new plans, rather than show any cancellations. Wait, it gets worse. I got my invoice for my new plan BEFORE I got any details on this new plan. Yessir, I was billed for something I had not agreed to buy, for a product I had no real knowledge of.

      Yep, ZERO EFFECT!

      1. How is your health now? How was it before the plan change?

        See? Zero-effect!

        1. Stress is health, right? Well, that extra $240/mo. has been a jolt to my health.

          Let me guess, you have an employer-based plan and have yet to pay any of the freight on this new law?

      2. Deductibles more than doubled over the last two years, premiums up around 30%, same period. Claims being denied like crazy, many of which weren’t before. All with a major provider.

        Yeah, that’s one of the blessings of this horrifically stupid law. When is it getting repealed again?

        1. Personal anecdotal evidence shows that insurance companies are much more stringent and quicker to pull the “denied” lever more than ever.

          When I lost my job, we moved our daughter to my ex wife’s insurance. They tried to deny coverage because there was no proof that she was her mother’s daughter– an insurance she had been on years before with no issue.

          So now her mother is having to dig through copious records to provide proof- birth certificate not being adequate.

          1. Christ that sucks

            1. Eh, my ex wife has been married more times than Liz Taylor. Her last name history is a venn diagram more awful than Tony villaraigosa’s.

              She even joked, “what do I gotta do, parade all my ex husband’s through and have them vouch for me?”

    3. Yup, I think most of the “new” enrollees were people like me whose individual coverage was canceled because of Ocare. I didn’t take them up on their offer to triple my premium for the same coverage. I got a new job though and get insurance through them, which is a bit more expensive now thanks to Ocare.

    4. Counting medicaid recipients as “insured” is among the most dishonest ACA math there is. Medicaid is NOT insurance. By that logic, My family was “insured” under Healthy way LA.

      And those who are covered by ACA medicaid expansion were either already eligible or was upgraded from state ran plans.

    5. “Medicaid doesn’t count. Its not insurance, its welfare”

      Yeah – and a whole lot of what is nominally called insurance is also welfare.

      When the government uses force to make people buy insurance and uses force to determine what that insurance has to cover and uses force to make insurance companies take people with people with preexisting conditions and uses force to make younger and healthier people pay higher rates than actuarially warranted so that the old and can pay less than actuarially warranted, there is WHOLE lot of welfare going on.

    6. Zero effect? That’s laughable. My wife and I are trying to decide what to do right now. I’m the breadwinner salary-wise, but I’m hourly while i’m finishing up law school, so I don’t get the benefits that normally go with the salary that I’m making. My wife works a job she hates, making $15/hr, simply because she gets relatively cheap insurance for the both of us while I’m in school.

      If it wasn’t for insurance, she’d be picking up part-time odd jobs and working on cutting down expenses at home (we’d probably have a kid, too). However, as of today, the only non-employer insurance options we have is $500/month for high-deductible insurance through school, $358/month for $12,700 deductible shit insurance through Ocare, or $543/month for $1000 deductible, $13k out of pocket shit insurance.

      Zero effect? hahaha

      1. Pre-Ocare, I was paying $45 a month for a “high-deductible” ($1000) HSA, and my wife was paying $30 a month for a similar plan. Our options have grown by 5x the cost for the shittiest insurance, or 7-8x the cost for something remotely similar, yet still massively inferior.

  4. Ok, let’s go back to the goals of OCare, as outlined by Obama himself:
    1) get coverage for the “more than 30 million American citizens who cannot get coverage.” Let’s assume all of the increase is due to OCare, we’ll give him a partially achieved.
    2) “More and more Americans worry that if you move, lose your job, or change your job, you’ll lose your health insurance too.” Well you still lose your insurance if you lose your job and were getting it through your employer. And if you move across state lines, you still lose your insurance. Maybe it’s a bit easier to get a different policy after you lose your job or move, but given the shitty way the government runs the exchanges, I’m not so sure. Mostly failed.
    3) “More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won’t pay the full cost of care.” This was basically a myth in the first place, and insurance still doesn’t cover the full cost of most care. The exchanges actually offered deductibles that are quite a bit higher than most employer sponsored insurance. Definite fail.

    1. Let’s assume all of the increase is due to OCare, we’ll give him a partially achieved.

      Let’s not assume that. Because its not true.

      A lot of it, maybe all of it, has to be due to more jobs.

      The mystery is, to me, how the increase in population nets out against the increase in people with and without health insurance. If population grew by 6 million, and the number of people with insurance grew by 7.3mm, doesn’t that mean we only decreased the number of people who are uninsured by 1.3mm? Have we gone from 30mm w/o coverage to 28.7mm without coverage? If so, I count that as a fail.

    2. Maybe it’s a bit easier to get a different policy after you lose your job or move

      It’s not. It’s harder now. Before you could just go sign up for individual coverage. Now you have to give a bunch of income info first. It became much more complicated. Oh, and pay more. Much more.

  5. 4) “Then there’s the problem of rising cost. We spend one and a half times more per person on health care than any other country, but we aren’t any healthier for it.” Cost are still going up. Another fail.
    5) “And it’s why those of us with health insurance are also paying a hidden and growing tax for those without it — about $1,000 per year that pays for somebody else’s emergency room and charitable care.” Well he completely fixed that one for us. Now the tax isn’t hidden. It’s right there on my 1040. Thanks O!
    6) “If we do nothing to slow these skyrocketing costs, we will eventually be spending more on Medicare and Medicaid than every other government program combined.” Medicaid spending is going up even faster now that he expanded it. And he’s now added the costs of subsidies on the exchanges. Double fail.

  6. I was promised an apocalypse.

    1. I was promised a unicorn.

      1. Both of you got what you were promised. Tony got a revelation, and you got the horn.

    2. Wait for it…. Rome wasn’t collapsed in a day, ya know.

    3. The death spiral is only in its infancy. It’s being held off by illegal delays in implementing the employer mandates.

    4. Strawman skewered. I guess all those people whose costs went up can go fuck themselves, because the law’s result is somewhat less than an apocalypse.

    5. “I was promised an apocalypse.”

      Were you also promised an extra brain cell so you’d have a matched pair?

  7. As a “beneficiary” of Obama care, I try to look objectively through my eyes and experience, and I don’t see a major positive.

    I lost my job in July of 2014. When my insurance/severance period ended, I signed up through the Washington state exchange. Insurance that came within 10,000 miles of my previous employers coverage was expensive. Very expensive. Like… Unaffordable expensive. So I signed up for a super-high deductible plan for a little over $300 a month.

    The only reason I could afford this plan at all is two-fold: I was on unemployment, and dear old mom died and left me with a lump sum inheritance with which I could cover the differences by stealing from my retirement.

    Had I not had either of these things, I’d have gone to Medicaid.

    I’m not sure how Obama care has meaningfully changed the landscape.

    As of now, I’m employed as a contractor, but without insurance, so I remain on the exchange- same high deductible, but able to cover the cost without stealing from my retirement.

    1. Before Obamacare, you probably could have bought roughly the same plan for roughly the same amount on the open market so long as you didn’t have a disqualifying pre-existing condition. It’s not as if Obamacare created the individual insurance market.

      1. Exactly. The pre-existing condition is the toughest nut to crack, exacerbated of course by the high price of healthcare due to government interference in markets.

        Imagine what iPhones would cost they were a human right.

        1. And imagine how shitty they would be.

    2. I’m not sure how Obama care has meaningfully changed the landscape.

      Before Ocare that policy would have cost you less than $150/mo.

    1. Speaking of informative stuff on TV, just caught an excellent doc on Netflix on Gettysburg, narrated by Sam Rockwell. Highly recommended.

  8. 16.9 million people have gained insurance between September 2013 and February 2015?with 22.8 million newly insured and 5.9 million having lost coverage

    I know this was “on net”, but still it seems a weird factoid. Did the 5.9 million die, or what?

    1. No, they gave up their plans when nearly everyone on the individual market got flushed to the exchanges, or they lost their jobs, and haven’t bought a new policy.

  9. OT: Exit polling shows the UK decides to keep it’s socialism Conservative flavoured, SNP crushes it in Scotland.

    The poll showed that the Tories will win 316 seats, an increase of nine from their 2010 total, leaving Mr Cameron in the strongest position to form a government.
    The SNP were expected to make dramatic breakthrough in Westminster, winning 58 of 59 seats in Scotland and wiping out Labour north of the border.
    The predicted rise of Nicola Sturgeon’s party left Labour with just 239 seats, a collapse in support from the 258 they received in 2010.
    The Liberal Democrats were forecast to suffer a collapse and be left with just 10 MPs ? down from 57 in 2010.

    1. However, there is another exit poll more in line with pre-election polling:

      YouGov survey also suggests Tories largest party, albeit by a much smaller margin: Conservative: 284, Labour: 263, SNP: 48, Lib Dems: 31, Ukip: 2, PC: 3 ,Green: 1

      And of course there’s no exit polling for mail-in ballots, which have been stuffed by community leaders in right places.
      Still, this is awesome to watch – some people have NHL playoffs, I have crazy, tight elections in a country that’s an ocean from me so I can literally feel no pain. Worse off they are, cheaper England trip for me!

  10. Does anyone find it interesting that the Obamacare cheerleaders have gone from claiming it will be the magical elixir which will save the healthcare system and provide coverage to the oppressed, to indicating that it hasn’t completely burned the country to the ground?

    1. Yeah, I’ve noticed that, too. Yet it has been said all along that some of the disaster has been intentionally deferred, which the cheerleaders like to pretend they haven’t heard.

    2. I think it is interesting that the DEATH SPIRAL! monkeys have stopped screaming about how awful it would be and now say it is having “zero” net effect after tweaking the numbers in their favor (see RC DEAN).

      I’ll wait for Price Waterhouse to revise the costs (they had said premiums fell 20% while deductibles shot up 40%) overall.

      I know I have been the one saying all along it was a big nothing and a wasted of time because only less than 10% are effected by the law.

      And for those anecdotal BUT MY PREMIUM WENT UP! types – shop around you dumbshits. It is a big market out there (albeit not a free one).

      1. Palin’s Buttplug|5.7.15 @ 7:26PM|#
        “I think it is interesting that the DEATH SPIRAL! monkeys have stopped screaming about how awful it would be and now say it is having “zero” net effect after tweaking the numbers in their favor (see RC DEAN).”

        Turd, for starters, O-care has been illegally handing out the vig, and the mandate has yet to be enforced, so any real damage is awaiting O-care being implemented.
        The parts we do have managed (per the count above) to do nearly nothing as far as spreading insurance, it has run up costs by a ton and we now have another huge bureaucracy, and SHITSTAINS LIKE YOU SAY “SEE! IT’S NOT THAT BAD!”
        Fuck off, you slimy piece of shit


    3. Isn’t that the same approach statists take towards every one of their disastrous ideas? I mean, every single one?

  11. Have all the features of Obamacare started yet? My former employer is looking at 2016 as the year he will have to pay a penalty for a “Cadillac” plan so something has got to give: lower profits, less coverage, or more premiums charged to employees. No good economic outcomes there.

    1. The Obamacare subsidies question hasn’t even been resolved yet.

      1. Delay, Deceive, Defraud.

        1. “Delay, Deceive, Defraud.”

          As seen in Nancy Pelosis plastic surgeons office.

          1. You know what else we had to pass to know what was in it?

            1. Your…your stool?

            2. The Gyro I drunkenly purchased from a food truck last Saturday night?

            3. Tom Brady’s footballs?

  12. Obamacare is just another communist mandate by the progressive communists who claim to be pro-choice.

    1. Why yes. Heritage came up with it as a “market-based” alternative to Hillary-Care.

      1. Palin’s Buttplug|5.7.15 @ 7:28PM|#
        “Why yes. Heritage came up with it as a “market-based” alternative to Hillary-Care.”

        Cite missing, turd.
        And it better be O-care, not some ‘well, it sorta looks like…’

      2. Not exactly. The particulars of Heritage’s plan were quite different from Obamacare.

        Heritage’s TL,DR in response to the government citing them as an authority on the matter:

        Heritage policy experts never supported an unqualified mandate like that in the PPACA [ObamaCare]. Their prior support for a qualified mandate was limited to catastrophic coverage (true insurance that is precisely what the PPACA forbids), coupled with tax relief for all families and other reforms that are conspicuously absent from the PPACA. Since then, a growing body of research has provided a strong basis to conclude that any government insurance mandate is not only unnecessary, but is a bad policy option. Moreover, Heritage’s legal scholars have been consistent in explaining that the type of mandate in the PPACA is unconstitutional.

        1. Thanks, KDN, that is exactly the sort of lie for which turd is famous:
          ‘Well someone other than a proggie said exactly the same thing! Sort of. Kinda.’

  13. Let us never, ever, ever forget that ten years ago, in the crazy wild west of free market health care that was destroying us, the government was already spending 39 FREAKING PERCENT of health dollars. This was the horrible scourge that democrats paraded before us and that republicans were too …….. — I don’t know what! — to challenge.


  14. My Aunty Kayla recently got a stunning green Dodge Caliber Wagon just by working online with a pc.
    look at this site ????????????? http://www.jobsfish.com

  15. “So while it provides a potential sketch as to what’s happening, it’s not the world’s most precise measure.”

    We really need a nice, comprehensive study of the plan and the results, so that when we tell ObamaCare supporters “I told you so”, there’s as little wriggle-room as possible. I don’t need a ton of evidence to tell me that a coercive government plan is unlikely to reduce costs or make health care better, but all those pragmatists and utilitarians and the various statists really need to be drowned in data to make them get the point.

  16. Nathaniel . although Stephanie `s rep0rt is super… I just bought a top of the range Mercedes sincee geting a check for $4416 this last four weeks and would you believe, ten/k last-month . no-doubt about it, this really is the best-job I’ve ever done . I actually started seven months/ago and almost straight away started making a nice over $79.. p/h….. ?????? http://www.Jobs-Cash.com

  17. Nathaniel . although Stephanie `s rep0rt is super… I just bought a top of the range Mercedes sincee geting a check for $4416 this last four weeks and would you believe, ten/k last-month . no-doubt about it, this really is the best-job I’ve ever done . I actually started seven months/ago and almost straight away started making a nice over $79.. p/h….. ?????? http://www.Jobs-Cash.com

Please to post comments

Comments are closed.