Sunday, December 28, 2014

Obamacare: Pain but No Gain in Driving Down Uninsured

President Obama in a speech to Congress in September 2009, stated that the central goal of the Accountable Care Act (aka Obamacare), is extending health care coverage to the "...more than 30 million American citizens who cannot get coverage." Yet here we are less than two weeks away from the end of open enrollment and the number of Americans who lack insurance is still 30 million. A 'back of the envelope' estimate helps make the point. Although the math cannot be precise, the underlying logic is difficult to refute.

Obamacare: Pain but No Gain in Driving Down Uninsured

President Obama in a speech to Congress in September 2009, stated that the central goal of the Accountable Care Act (aka Obamacare), is extending health care coverage to the “…more than 30 million American citizens who cannot get coverage.” Yet here we are less than two weeks away from the end of open enrollment and the number of Americans who lack insurance is still 30 million. A ‘back of the envelope’ estimate helps make the point. Although the math cannot be precise, the underlying logic is difficult to refute.

Modern Healthcare reported a total of 48 million uninsured at the beginning of the Obamacare roll-out in October 2013.

Relying on statistics from the Kaiser Family Foundation, it is reasonable to assume 80 percent of these 48 million are U.S. citizens, eligible for health care coverage under the Federal law. This indicates that the magnitude of the uninsured grew from 30 million U.S. citizens in 2009 to 39 million U.S. citizens in 2013 – a more than 25% increase in the time leading up to open enrollment.

This growth in the uninsured was largely the product of an economy that only created 1.4 million new jobs (U.S. Bureau of Labor Statistics) for more than 8 million new Americans seeking work, accounting for nearly 7 million of the 9 million new uninsured emerging during that time.

So, nearly seven months after official roll out of the Law, how far has Obamacare come in reducing the ranks of the uninsured?

It is estimated that nearly 3 million individuals have signed up for Medicaid for the first time following implementation of the ACA.  Let’s assume that all of these individuals gained coverage because of the newly expanded Medicaid Program although it is likely that some were eligible for the program prior to the expansion. This suggests the Law has reduced the number of uninsured Americans to 36 million as a result of this one provision.

Another 4 million Americans have signed up for private health coverage on the new exchanges. Under a ‘best case’ scenario it is estimated this number could reach 6 million by the end of the open enrollment period at the end of this month. This would bring the total number of uninsured down once again to 30 million.

We know that the 5 to 6 million citizens with individual plans were canceled under Obamacare because they did not meet minimum coverage requirements dictated by the Law. However, to be conservative for this analysis we’ve assumed that all of the individuals affected by that change have regained coverage through their insurers. Therefore, their cancellations are presumed to have not ultimately changed the number of uninsured.

So, despite all of the new regulations, taxes and mandates brought on by Obamacare, there remain 30 million uninsured Americans. We have ended up right back where we started only more in debt and uncertain of what lies ahead.

Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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