“Bob, let’s look at the bottom line. The bottom line is this: 10 million Americans have health insurance today who would not have had it without the Affordable Care Act. Ten million.”
The Fact Checker has written often about the problems with claims based on the number of new insurance enrollees under the Affordable Care Act. Yet here is the second-ranking Democrat in the Senate trotting out the same tired talking point. So let’s review what’s wrong with this figure, especially if someone is using it to claim that these people are all newly insured.
Durbin appears to be combining two figures released by the administration: more 3 million signing up for insurance through the federal HealthCare.gov and state exchanges and 6.3 million deemed eligible for Medicaid. Both figures are generally October through December, and so obviously have increased since then.
But there are two big problems with both numbers:
a) The troubled federal exchange counts people as enrolled if an individual has selected a plan, but it does not know if a person enrolled and paid a premium because that part of the system has yet to be built.
b) The Affordable Care Act expanded Medicaid eligibility, but no one really knows how many of the 6.3 million are in this expansion pool — or whether they are simply renewing or would have qualified for Medicaid before the new law. Indeed, the number also includes people joining Medicaid in states that chose not accept the expansion.
Obviously, then, these figures must be treated with caution. But Durbin went a step further and claimed that all of these people would not have had health insurance if not for the Affordable Care Act.
That’s simply ridiculous. For instance, members of Congress, such as Durbin, previously had health insurance and are now obligated to get it via the exchanges. But the problem goes deeper than that.
The Wall Street Journal in January detailed some of the surveys that have taken of people who obtained insurance through the exchanges, and the results so far indicate that the vast majority of enrollees were previously insured.
- Only 11 percent of consumers who bought new coverage under the law were previously uninsured, according to a McKinsey & Co. survey
- HealthMarkets Inc., an insurance agency that enrolled around 7,500 people in exchange plans, said 65 percent of its enrollees had prior coverage.
- At Michigan-based Priority Health, only 25 percent of more than 1,000 enrollees surveyed in plans that comply with the law were previously uninsured.
Of course, these percentages may change with time. 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. But even so, that would suggest at least a third already had insurance. (Update: New York state says that two-thirds of the people who enrolled on its exchange were previously uninsured, in line with the Avalere estimate.)
Meanwhile, just last week Avalere threw cold water on the 6.3 million Medicaid figure, estimating that only 1.1 to 1.8 million of the enrollees could be attributed to the Affordable Care Act. That estimate generated headlines, including a full report in The Washington Post that said it suggested “many of the people who have joined the program since the initiative’s rollout in October would have done so absent the law.”
In other words, the Medicaid enrollment numbers are so suspect that, at this point, they should not be used in any formulation regarding the Affordable Care Act. That may change as more information is received, but politicians (and reporters) should be cautious now. (At least one analyst has called into question Avalere’s analysis, which further demonstrates the caution that is necessary.)
Durbin’s office declined to comment. Update: After this column appeared, Durbin spokesman Max Gleischman provided this statement: “Fact check after fact check has confirmed that more than 9 million Americans have signed up for private health insurance or Medicaid coverage through Affordable Care Act. Many of the more than 9 million Americans are being covered for the first time. No matter the number of new enrollees, there is no question that the law is working and millions of people are realizing the benefits of affordable health coverage and the protections it guarantees.”
[The Fact Checker is unaware of any fact checks that have confirmed these figures as all ACA enrollments or evidence that “many" of the enrollees are being covered for the first time.]
The Pinocchio Test
Even if one took the high end of these estimates, the most one could claim is that about 4 million people have gained insurance because the Affordable Care Act, but that’s being extraordinarily generous.
In the meantime, given the fuzzy nature of the numbers and the wide publicity devoted to the recent surveys, Durbin has little excuse for going on national television and claiming that every one of these people had been previously uninsured. This has now become a Four Pinocchio violation.
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