When it comes to ACA statistics, you usually have to look beneath the spin. According to the NYT, the Obama Administration has just recently announced that 11.4 million Americans have “selected or renewed” insurance through the ACA’s exchanges, but Avik Roy has a helpful piece at Forbes breaking down the numbers along two dimensions. The first is retention: Roy notes that only 84 percent of Americans who signed up for Obamacare last year wound up paying their premiums (and thus keeping their plans). That’s pretty standard for the insurance industry, but when you combine it with the number of people who were previously insured, the ACA numbers start to look a lot smaller:
We don’t know the actual number of Obamacare exchange enrollees who were previously uninsured, because the Obama administration hasn’t tracked those statistics. But we do know that at least 4.7 million Americans received cancellation notices in 2013, because Obamacare’s regulations made their health plans illegal. Based on survey data from McKinsey, last May I estimated that 2.6 million previously uninsured individuals gained private non-group coverage. A survey by the Kaiser Family Foundation found that 57% of those with exchange-based coverage were previously uninsured, which would amount to 3.8 million in 2014.We also can’t predict whether or not the uninsured fraction will be higher in 2015 than it was in 2014. But if we carry forward the more generous Kaiser estimate of 57%, and combine it with the 84% retention rate, we can estimate that about 5.4 million previously uninsured individuals would be enrolled in Obamacare’s exchanges by the end of the 2015 enrollment period, based on current figures.
Roy notes that his 5.4 million enrollment estimate for 2015 takes into account the fact that fewer people are expected to sign up this year. If current trends hold, this year’s signups will be about 58 percent fewer than last year’s. Roy speculates that one reason for the slowdown is the high cost of the plans.There are greater causes for skepticism than Roy’s piece suggests, however. Even assuming that those 5.4 million Americans (if Roy’s figures are correct) are genuinely those insured for the very first time, their coverage often doesn’t work very well for them. So drilling down past official statistics to the true number of newly insured is only the first step in understanding how well the ACA is working. You also have to figure out how insurance plans are playing out on the ground. Without that information, official coverage numbers tell you a lot less than you might think.