“Right now, as we speak, there are 9 million Americans who have health care that didn’t have it before.”

— Senate Majority Leader Harry Reid (D-Nev.), interview on CBS’s “Face the Nation,” Jan. 5, 2014

The rating on this column has been revised.

There have been lots of numbers tossed around about enrollment under the Affordable Care Act, a.k.a. Obamacare, but Reid’s figure certainly jumped out at us, given that the administration is backing away from its initial target of 7 million enrollees on the exchanges.

Here’s the math that Reid presented during his television interview:

  • “We have 3 million on their policies because they haven’t reached age 26, so they can stay on their parents’ policy.”
  • “We have 3 million Medicare.” (Oops, we instantly knew he meant to say Medicaid. Medicare is for the over-65 set.)
  •  “We have more than 2 million that are coming” on the exchanges.

Hmm, 3+3+2 actually equals 8. But the most recent estimate for Medicaid enrollment is actually around 4 million. (The figures vary between 3.9 million and 4.4 million, but numbers are a bit fuzzy because some states are including people who are already on Medicaid or other low-income health programs.)

So, 3+4+2 would equal 9. But is Reid correct that all of these are newly insured?

The Facts

Let’s look closely at each of these numbers.

Reid’s claim that there are 3 million Americans under the age of 26 now on their parents’ policies comes from a 2012 estimate produced by the research arm of the Department of Health and Human Services. This is one of the ACA policies that took effect almost immediately, and the data showed a sharp increase in people between the ages of 19 and 25 suddenly receiving private insurance.

Reid here chose a more conservative figure. Some people like to cite a much higher number — 7.8 million, from the Commonwealth Fund — but that figure includes people who were not previously uninsured.

As for Medicaid, Reid is highlighting a less appreciated fact about the law — that in the first year, more people are expected to gain health care through an expansion of the health-care program for low-income Americans.

Remember the Congressional Budget Office estimate that 7 million would get insurance through the exchanges in 2014? The CBO estimate for the boost in Medicaid enrollment is actually 9 million people.

Not all states accepted the Medicaid expansion. But there is evidence that tens of thousands of people who were previously eligible for Medicaid but did not apply before have now signed up because of the publicity surrounding the rollout of the Affordable Care Act. This is known as the “woodwork” or “welcome mat” effect.

But Reid cannot really claim that all those in the Medicaid pool are people who previously did not have insurance. More than 600,000, for instance, were transferred in California from another health-care program. (Showing how fuzzy these figures may be, Sean Trende at Real Clear Politics argues few of the 4 million in sign-ups for Medicaid can be attributed to the Affordable Care Act. He says the real number could be as low as 190,000.) Update: There are serious issues with the 3.9 million figure.

Finally, there are 2.1 million people who have signed up for the exchanges. But here Reid is also overstating the pool of enrollees. As we have noted, it is unclear at this point how many people in this pool have actually received coverage; this figure only reflects the number of people who have selected a plan.

But, more important, the number includes hundreds of thousands of people — including Reid himself — who previously had insurance but have now shifted to the exchanges.

Avalere, a health consulting firm, estimates that, once the law is fully implemented in 2017, about 68 percent of the people who obtained insurance through the exchanges will be newly insured. Under that ratio, the number of people currently enrolled who did not previously have insurance would be about 1.4 million.

“It’s true that we don’t know whether all of those people would have been insured or uninsured before the passage of ACA, but many of them fit the profile of those likely to be uninsured prior the passage of the Affordable Care Act,” Reid spokesman Adam Jentleson said.

The Pinocchio Test

Reid would have been on more solid ground if he had framed his numbers correctly — that about 9 million people now have health coverage through provisions in the Affordable Care Act. (For the moment, we will accept the 4 million figure for Medicaid, but that could be subject to change as more data roll in.)  Instead, he strained too far and asserted that all of these Americans did not have health coverage before. That’s not correct.

Update: We determined that there are serious problems with the Medicaid figure, and awarded ourselves Three Pinocchios for allowing it to stand. We have also updated this rating to Three Pinocchios.

Three Pinocchios

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