SEPT 16, 2015 – The Census Bureau has finally released definitive statistics on the number of uninsured in 2014 and the news is not good for Obamacare (unless, of course, you have abysmally low expectations for government performance). The population-wide uninsured rate fell from 14.5% in calendar year 2013 to 11.7% in 2014. The total number of uninsured dropped from 45.2 million in 2013 to 36.7 million in 2014–a net of 8.5 million who gained coverage .
There are 2 things to note about this new number, which is far more definitive than the previous numbers put out by Urban Institute, RAND Corporation, Commonwealth Fund, Gallup or even the CDC’s National Health Interview Survey (NHIS):
- The actual gain in coverage–8.5 million–is well below previously-released estimates of the reduction in the number of uninsured achieved in 2014
- It also is well below official government projections of how many uninsured would gain coverage under Obamacare
Why is the figure so much more definitive? The Census Bureau figures released today that I’ve cited above come from the American Community Survey (ACS), which is based on a survey of about 3.5 million households (about 8.8 million people). In contrast, the NHIS surveys only 87,500 people and all the other surveys focus exclusively on adults, hence cannot provide an accurate population-wide estimate of changes in the number of uninsured. Moreover, these private surveys also are considerably smaller: Gallup surveys less than 44,000 adults 18 and over, Urban Institute samples about 7,500 non-elderly adults, Commonwealth Surveys less than 6,200 non-elderly adults and RAND surveys less than 2,500 non-elderly adults.
Previous Estimates of Coverage Gains
Previous estimates of the net number of uninsured who gained coverage in 2014 ranged from 9.5 million non-elderly adults (Commonwealth) to 10.6 million (Urban Institute). Some pro-ACA pundits claimed even higher coverage gains:
- Charles Gaba at ACASign-ups used Gallup results for non-elderly adults to estimate a net gain of about 12 million, inclusive of children.
- Likewise, New Republic‘s Jonathan Cohn had misleadingly claimed that if one counted 1 to 2.5 million uninsured young adults who may have gotten covered prior to 2014, the total reduction in coverage came “close or equal to” the CBO projection that the number of uninsured would be reduced by 12 million in 2014. The reason this claim is misleading is that the CBO had predicted an absolute decline of 12 million uninsured between 2013 and 2014 inclusive of whatever effects the coverage of young adults might have had in that time-frame .
- Obamacare Facts claimed that by the end of the 2014 open enrollment period, 15 million previously uninsured had gained coverage .
In short, and perhaps unsurprisingly, ACA enthusiasts took already-thin evidence and exaggerated it to proportions more to their liking–i.e., inflating actual coverage gains by anywhere from 40 to 75%. It is little wonder that their enthusiasm remained undiminished for so long in the face of their own distorted perceptions of reality on the ground.
Official Projections of Coverage Gains
Second, the gain in coverage likewise lags far behind official government projections of what Obamacare had been expected to achieve. For example, around the time Congress passed the bill, the Medicare actuary (at Centers for Medicare and Medicaid Services or CMS) had predicted that the number of uninsured would decline by 23.8 million just in its first year! The Congressional Budget Office (CBO) had been somewhat more cautious, but nevertheless expected Obamacare to reduce the number of uninsured by 18 million between 2013 and 2014 alone.