Organizing For Action, digital mouthpiece for the Obama White House, tweets that 6 Million people now have health insurance due to ObamaCare. Where did that number come from? According to The Fact Checker, that is the total of those reported as signed up through an exchange and Medicaid enrollees.
The 6 million figure comes from combining a figure of 2.1 million for people selecting a plan via state and federal exchanges, through December, and 3.9 million for Medicaid, through November. Thus the claim that “6 million Americans have already signed up for coverage thanks to health reform.”
There have been legitimate questions raised about the numbers enrolled through exchanges, but the 3.9 million signed up for Medicaid has been widely accepted by media – even Fact Checker.
Now comes a comprehensive analysis of those Medicaid numbers by Sean Trende of Real Clear Politics which puts that 3.9 million figure in serious doubt. So much so, that Fact Checker refutes the figure.
We’re awarding Three Pinocchios to everyone, including The Fact Checker, who improperly used this number or left the wrong impression about it.
Sean Trende’s article addresses enrollment totals proffered by the White House and ACA advocates, and the arguments raised by those on both sides of the health care debate, before delving into those questionable Medicaid enrollment numbers.
The White House has propagated numbers regarding sign-ups for the Affordable Care Act, claiming that the program is responsible for 4 million people gaining coverage through Medicaid expansion; 3 million enrollees in their early 20s who remain on their parents’ policies; and 2 million who have purchased insurance through the exchanges.
All of these numbers have issues. Objections to the latter two — as well as the rejoinders to these objections — have been discussed extensively, and I will not rehash them here. Suffice it to say that at least some of these people had insurance before the ACA went into effect, and would obtain insurance if the ACA were repealed.
But I haven’t really seen much discussion about the Medicaid figures. The 4 million new beneficiaries seems to be taking on near-canonical status, even being used by the fact checkers at the Washington Post for evaluating GOP claims.
This is odd, because after looking carefully at the numbers cited, the Medicaid figures are the weakest of the bunch. It’s a virtual certainty that the number of enrollments attributable to Obamacare is an order of magnitude less than the 4 million sign-ups implied, and the number of people [on Medicaid] who would actually lose their insurance if Obamacare were repealed is probably around 200,000 to 300,000.
The problem is identified in this Ezra Klein column (emphasis mine):
“Meanwhile, in October and November alone, more than 4 million people signed up for Medicaid coverage. This number will be much higher when December’s totals are released. It’s hard to say exactly how many of those Medicaid enrollments Obamacare is responsible for — the government’s numbers don’t distinguish between people who signed up through Obamacare’s Medicaid expansion and those who entered the program through pre-existing channels. But the fact remains that Medicaid enrolled well over twice as many people as signed up for private insurance through the exchanges.”
As Trende notes, that is a very important point when trying to evaluate the true impact of ObamaCare on Medicaid enrollment. The first issue was to separate enrollments in states which expanded Medicaid eligibility under the ACA from enrollments in those states which did not.
So, how many of these 4 million sign-ups are attributable to Obamacare, and how many of them are just people who entered the system under the earlier rules? The “4 million” number derives from this document, published Dec. 20 by the Centers for Medicare & Medicaid Services. It reports on the November enrollment numbers. There’s a similar document for October here.*
Let’s turn to this chart, which tells us the number of applications for financial assistance received by states in October and November (4,209,742, of which 1,736,809 applied in November), and the number of people who were determined eligible for both Medicaid and the Children’s Health Insurance Program (3,926,068, of which 1,741,011 were determined eligible in November). These numbers are where the “4 million” comes from.
CMS has published the numbers by state. It has also helpfully — and critically — sorted these numbers by states that have implemented the Obamacare Medicaid expansion and those that have not (the charts are big; I’ve relegated them to the end of this piece for the sake of readability. To see slightly larger versions, look here and here).
The above chart tells us that 1.7 million people were determined eligible for Medicaid in November of this year alone. The charts at the end tell us that 780,000 of these enrollees were in states that have undertaken the Obamacare expansion, while 960,000 of them were in states that have not done so.
So, of the November enrollees, 55 percent are in states where the Obamacare expansion of coverage didn’t occur and the ACA is therefore very unlikely to be directly responsible for their coverage. If we look at the October numbers, a little less than half (49.82 percent) were in states that didn’t expand coverage. Therefore, in total, of the 3.9 million individuals newly covered by Medicaid in October or November, only about 1.9 million are from states that expanded Medicaid.
By eliminating counts from states which did not expand Medicaid, and therefore unaffected by ACA changes, that widely reported 3.9 million enrollment number drops to a more realistic 1.9 million enrollments under ObamaCare rules. Yet, even that number does not account for those people who would have signed up for Medicaid anyway. To determine what increase was due to ObamaCare, Trende compared prior enrollment numbers for states with and without Medicaid expansion, arriving at a ballpark estimate that those with the expansion showed a 10% increase over those without.
Which brings us back to our number above: 1.9 million total enrollees approved in October or November in states that actually expanded Medicaid. If we are correct in our assumptions above—that is, if 10 percent of these enrollees are due to the Obamacare expansion—then we have an actual estimate for Medicaid enrollment due directly to the ACA’s expansion of Medicaid: 190,000.
We should remember that there are people who applied through the exchanges and were found eligible for Medicaid who aren’t included in this estimate. We should also emphasize that the numbers for November are still preliminary. On the other hand, we (necessarily) lumped together people who applied for Medicaid and CHIP in our data.
More importantly, several states that expanded Medicaid advertised this fact heavily and probably attracted a disproportionate number of people who were already eligible for Medicaid but didn’t know it. While it’s probably fair to attribute these enrollees to Obamacare, they would keep their coverage in the event of a repeal, and might not figure heavily in November. Regardless, even if you double the estimate — which seems awfully generous — that’s only 380,000 new Medicaid enrollees due to Obamacare, a far cry from 4 million.
A far cry indeed.
Dennis P. O’Neil