“There are now 22 million people with affordable coverage thanks to the Affordable Care Act, and that’s a big deal and that number will grow.”
— Former Health and Human Services secretary Kathleen Sebelius, in a speech at the Aspen Ideas Festival, June 27, 2014
This number — 22 million — is an interesting figure from the recently departed HHS secretary, given that she had once famously defined “success” for the Affordable Care Act as having signed up 7 million people by the end of March.
How did the number suddenly balloon to 22 million?
Brad Kemp, an aide to Sebelius, provided the following breakdown: “8 million in market; 3 million young adults; 5 million in ACA-compliant off-market plans, and 6 million (and counting) additional Medicaid folks.”
That adds up to 22 million, but he did not respond to follow-up e-mails or provide any sources for the numbers. So let’s dissect these figures ourselves.
‘8 million in market’
Eight million refers to the number of people who selected a plan in the ACA exchanges. At this point, we don’t know how many have actually paid their first month’s premiums, but most analysts are assuming a rate of about 90 percent, which would be about 7.2 million. While the sign-up period has ended, people who have a change-of-life situation, such as a new child or a marriage, can still buy a new plan, so the year-end number is still a moving target. Charles Gaba, who closely tracks these numbers at ACAsignups.net, believes the number of paid enrollees is now about 7.7 million.
As we have explained before, the CBO estimate that formed the basis for Sebelius’s earlier hope of 7 million sign-ups was a calendar-year estimate, not a prediction of how many people would be enrolled by March 31. Indeed, because of the stumbling start of HealthCare.gov, CBO lowered its prediction to 6 million.
But with those caveats, Sebelius is on relatively solid ground to cite 8 million in the exchanges–at least until actual enrollment figures are known.
‘6 million (and counting) additional Medicaid folks’
The expansion of Medicaid is another key component of the ACA, though the Supreme Court weakened it by making it optional for states.
Here, Sebelius appears to be relying on an April report from HHS, which counted about 5 million new enrollees and about 1 million transferred from state programs for the poor. There’s also another 2 million or so people who were previously eligible for Medicaid but never signed up; they came out of the “woodwork” because of the publicity about Obamacare.
Experts differ on whether they should be included or not, but Sebelius appears to have taken a conservative approach with this element of her calculation. There is no sign-up deadline for Medicaid, so that number has likely grown since April as well.
‘3 million young adults’
This refers to the number of adults under of age of 26 who have joined their parents’ plan as a result of the law. But “3 million” is a problematic number.
This is a two-year-old figure, based on a Health and Human Services Department estimate, and so it is a bit dubious. The Fact Checker dug into the more recent reports and found that it was based on a single quarterly figure that was not sustained in later quarters. At best, one could claim perhaps a gain of 2 million, but several analysts have raised serious questions about the methodology of the original report and suggest the actual figure could be lower than 1 million.
Thus Sebelius is on shaky ground here. The administration originally began citing this figure as way to claim some initial success with the law, but given that there are now millions of people actually enrolled in the exchanges, it’s time to drop this iffy statistic.
‘5 million in ACA-compliant off-market plans’
This is the most controversial part of Sebelius’s calculation. Off-market plans are sold directly by insurance brokers or insurance companies, meaning they generally do not qualify for Obamacare subsidies. (An insurance agent could help someone enroll on an exchange if they have proper certification.) But off-market plans do include the protections included in the law, such as guaranteed coverage for people with preexisting conditions and a package of essential benefits.
Still, CBO calculated that the number of off-exchange plans would drop from about 10 million to 5 million as people moved to buying insurance on the exchanges. So why should she tout a figure that was due to go down because of the law, especially because she said she was talking about people with “affordable coverage”?
Larry Levitt, senior vice president at the Kaiser Family Foundation, said that is a valid point. “It certainly qualifies as more affordable coverage for people with preexisting conditions who were locked out of the market before or faced rate surcharges because of their health status,” he said. “For others, the coverage likely offers better protection but may not be more affordable. So, it’s a mixed picture for people in ACA-compliant plans off the exchanges.”
There have been a variety of estimates for the number of off-exchanges plans sold, but no hard estimates. Five million is at the lower end of the range.
Update, July 3: An article in the New England Journal of Medicine pegged the number at 20 million. The authors credited just one million for young adults, but included the five million for off-exchange plans. However, the authors do not explain why they count this as a gain when the CBO says the ACA will lead to a reduction in off-market plans.
The Pinocchio Test
Given that Sebelius is touting “affordable coverage,” she should stick to citing the figures for the central parts of Obamacare — insurance bought on the exchanges and the expansion of Medicaid. Those are also relatively hard numbers, whereas the figures for the young adults and off-exchange plans are much fuzzier.
Since the administration actually exceeded the goal it had set for itself for exchange sign-ups, there’s really little reason to further pump up the number.
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