Perhaps the most remarkable thing about President Obama’s State of the Union speech last night is how little he said about the Affordable Care Act, his signature legislative achievement that continues to dominate national politics and public opinion about Washington, D.C.
The text of the President’s speech was twelve pages long. Less than a page was devoted to health care (about 460 words out of nearly 6,800), after which he quickly moved on to talk about gun control and immigration. He made no mention of the problems that have plagued the law’s rollout, offered no ideas about how to fix it, and did not acknowledge the estimated 5.4 million people who have had their insurance plans cancelled as a direct result of ACA regulations.
What he did manage to get into those 460 words was this data point: “More than nine million Americans have signed up for private health insurance or Medicaid coverage.”
That part about Medicaid is important because it accounts for about 6.3 million (or more than two-thirds) of those the administration claims the ACA has helped gain coverage. This figure comes from data published last week by the Centers for Medicare & Medicaid Services (CMS), which tallies Medicaid applications and admissions from October 1 to December 31.
As Sean Trende explained earlier this month, there is a crucial, hard-to-answer question behind these figures: how many of these sign-ups are because of ObamaCare and how many are people who entered the system through normal (pre-ObamaCare) channels?
As it did with October and November, CMS sorted the nearly 2.3 million new Medicaid enrollees for December by state, grouping states that have expanded Medicaid and states that have not. According to the data, 1.23 million new enrollees came from expansion states and 1.06 million came from non-expansion states (in November, these categories were inverted, with fewer enrollees from expansion than from non-expansion states—780,000 and 960,000, respectively.) In Texas, December saw a 15 percent drop in the number of applications compared to the monthly average from July through September of last year, before enrollment opened on the exchanges (94,666 versus 112,185).
Of the 3.9 million new Medicaid enrollees in October and November, only about 1.9 million were from states that expanded Medicaid. Add in the December numbers (1.23 million) and you have about 3.1 million who enrolled in Medicaid expansion states from October through December. As Trende noted in his analysis of the October and November numbers, we don’t know how many of those people were already eligible for Medicaid, and the CMS figures include CHIP enrollment, which isn’t part of the ObamaCare Medicaid expansion.
What do all these numbers mean? For one thing, it means that about half of the 6.3 million new Medicaid enrollees from October 1 to December 31 are not beneficiaries of ObamaCare, which means the President’s “more than nine million” figure is a gross exaggeration.
(Remember, also, that states sign up millions of people for Medicaid every month and that enrollees are constantly going on and off the program—what’s called “churn”—so the numbers of applications and enrollments in each state should be understood in that context.)
The rest of the “more than nine million” are those who have selected a private insurance plan on one of the ObamaCare exchanges—selected, not purchased. The U.S. Dept. of Health and Human Services is not releasing data about how many people have paid their first month’s premium and are in fact insured, so there is no way to know for sure.
But even assuming that most of those who select a plan have actually paid for it, the numbers are still remarkably low. In Texas, which has the highest uninsured rate in the country and about 6.2 million uninsured residents, only about 118,000 people had signed up for coverage on the exchange as of December 28.
Also remarkable is that most of those signing up are not in fact uninsured. According to the Wall Street Journal, of the 2.2 million people who enrolled in coverage on the exchanges through December, 65 to 90 percent were people who already had insurance. Megan McArdle noted last week that various sources estimate the number of previously uninsured people who have thus far signed up for coverage is less than 750,000 nationwide.
All this means that, for all the disruption and damage ObamaCare has wrought on businesses and individuals—including those 5.4 million Americans whose plans have been canceled—less than 4 million people nationwide have been covered as a result of the law, and the vast majority of these have been dumped into Medicaid, by far the worst form of coverage in the country.
No wonder the President was willing to exaggerate the ObamaCare numbers, gloss over the law’s problems, and quickly move on to other things in his State of the Union speech. So far, there isn’t much to brag about.