Saturday, November 22, 2014
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So how good is the good news on Obamacare and jobs?

The most recent Gallup-Healthways Well Being Index survey found that the percentage of those without health insurance in the U.S. has fallen to 13.4%. The unemployment rate in July fell to 6.2%. However, looking inside these numbers tells a somewhat different story.

So how good is the good news on Obamacare and jobs?

The most recent Gallup-Healthways Well Being Index survey found that the percentage of those without health insurance in the U.S. has fallen to 13.4%.  The unemployment rate in July fell to 6.2%.

However, looking inside these numbers tells a somewhat different story.  Gallup’s findings of the percentage of uninsured in the U.S. by quarter is presented in the table below:

Source: Gallup-Healthways Well-Being Index

But what can we understand by analyzing these numbers.  Here is my chart:

  Percentage Uninsured Total U.S. Population (in millions) Total U.S. Uninsured (in millions) Uninsured Non-Citizens Ineligible for Obamacare* (in millions) Uninsured U.S. Citizens (in millions)
Q1 2009 16.1 315 50 11 39
Q3 2013 18.0 317 57 11 46
Q2 2014 13.4 318 43 11 32
Change from 2009-2014 (2.7) 3.0 (7) -- (7)

*Assumes number of Uninsured, Non-Citizens is approximately 20% of the Total U.S. Uninsured and did not change significantly.

What observations might we make from these two charts?

  • The number of uninsured in the U.S. grew during the five years leading up to the roll-out of Obamacare by 7 million (i.e., Q1 2009 to Q3 2013).  It is likely that this growth was driven predominantly by chronic unemployment.
  • The highest rate of uninsured individuals in the U.S. occurred in the third quarter of 2013, immediately before the first year of open enrollment on the Obamacare insurance exchanges.
  • The reduction in uninsured from the peak in the third quarter of 2013 (18.0%) to the current rate (13.4%) is equivalent to 14 million.
  • An estimated 32 million U.S. citizens remain without health insurance.

From other sources we can draw additional conclusions. The U.S. Department of Health and Human Services reported that, as of the end of April, 6 million more individuals had signed up for Medicaid and Children’s Health Insurance Program (CHIP).  Therefore, only 8 million of the 14 million reported above gained insurance on the health insurance exchange.  Since the number of insured U.S. citizens had grown by 7 million, the net reduction in uninsured excluding Medicaid is only 1 million. 

While the decline in unemployment to 6.2% seems positive, a review of other statistics from the Bureau of Labor Statistics leads to a different conclusion.  We currently have one of the lowest labor participation rates (those over 16 seeking work) in recent history.  It stands at 62.9%.  The labor participation rate in the U.S. has never been below 66% in the last 20 years until 2010.  Other U.S. statistics confirm that the population has grown by 3 million, yet 1 million fewer are actually working.

So the findings on public approval of Obamacare in the latest Kaiser Health Tracking Poll, which tracks public attitudes toward the law, are not surprising.  The unfavorable rating for Obamacare is at its highest level, 53%, and the same poll indicates that the public wants the President and Congress to pay more attention to the economy and jobs.  The public’s interest in jobs stands at 70%, while its interest in healthcare is significantly less at 40%.

While progress has been made in insuring more Americans, predominantly through Medicaid expansion, the public recognizes that jobs are of a more immediate concern and, ultimately, jobs are the pathway to healthcare coverage for those other than persons over 65 and those eligible for Medicaid.

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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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