ACA at the SOTU: By the Numbers

February 21, 2014

A lot of numbers were thrown around during President Obama’s State of the Union address last month — number of veterans hired (400,000), number of schools poised to be connected to high speed broadband internet in the following year (15,000), number of autoworkers reemployed in a Detroit manufacturing firm (700).

Perhaps the most talked about, and scrutinized, number was this one: 9 million.

According to the President, “More than 9 million Americans have signed up for private health insurance or Medicaid coverage.”

This was an impressive figure, but what does it actually mean? Let’s break it down.

According to Administration numbers reported on January 24th, 6 million people were determined eligible for Medicaid coverage, either through existing programs in their states or through expanded coverage offered under the ACA. An additional 3 million enrolled in private health insurance exchanges (the number has since risen to 3.3 million), bringing the total to the magic number — 9 million.

Some critics suggest this number was problematic, not because it was inaccurate, but because it implied that the 9 million Americans who gained coverage were previously uninsured. In other words, the number implied that these people were getting health insurance for the first time.

It is difficult to differentiate between Medicaid-eligible or exchange-eligible individuals who were previously insured and those who are gaining insurance for the first time. According to the Gallup-Healthways Well-Being Index, the uninsured rate for U.S. adults dropped 1.2% in the month of January, from 17.3% to 16.1%. That would mean between 2 million and 3 million people got insurance (either on the public exchange or through the expanded Medicaid program) for the first time on January 1st.

So of the 9 million, two to three million were getting coverage for the first time.

Nine million is a big number and has been touted as evidence of the tide turning, and of the ACA’s success. But how does this number compare to Obama administration projections?

An initial target projected by the Congressional Budget Office, then endorsed by Kathleen Sebelius, was to have 7 million enrolled in plans on the public exchange by March 31st. The administration has since walked back that projection, alternatively identifying it as an “estimate” and a measure of success, but not actually a concrete target number for the exchange.

Nonetheless, 7 million has been the line in the sand. With 3 million enrolled and 2 months remaining, it remains to be seen if enrollment will reach that point in time to meet the target.

In the meantime, things are looking up for public opinion about the exchanges. A recent Gallup poll showed that of uninsured Americans who say they are “likely to get insurance,” over half plan to do so through an exchange website. This trend follows the increasingly streamlined online enrollment process that has largely recovered from a rocky rollout start.

The question remains — with all the numbers flying around, how many people need to enroll to consider the first open enrollment period a success? By some measures, it has already succeeded. By others, that won’t be determined until the final tally on March 31st.

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