A new report from the Commonwealth Fund claims 20 million Americans “gained coverage under the Affordable Care Act as of May 1.” But a closer look at that number reveals it’s not all it’s cracked up to be.
First, the authors, Dr. David Blumenthal, president of Commonwealth, and Vice President Sara Collins, get to the 20 million by adding together 1 million young adults who gained coverage under a parent’s policy, 8 million consumers who selected a marketplace plan, 5 million who purchased directly from an insurer, and 6 million who enrolled in Medicaid or the Children’s Health Insurance Program.
Also, the authors admit the 20 million figure does not distinguish between those who were previously insured and those who were not – even though the previously insured would not be “gaining” coverage but merely replacing one form of coverage with another.
And what about those 5 million who purchased coverage outside the exchanges? Is it fair to say they “gained” coverage because of the ACA? The authors site a Congressional Budget Office April 2014 report. Indeed, the CBO said, “[R]oughly 5 million people will enroll in ACA-compliant plans outside of the exchanges each year from 2014-2024.” (Page 9)
However, in the following paragraph, the CBO writes, “In the absence of the ACA, 9 million to 10 million people would have enrolled in nongroup coverage each year from 2014 through 2024, CBO and [the Joint Committee on Taxation] estimate. With roughly 5 million people expected to enroll in nongroup plans in years after 2015 under the ACA (excluding those people who purchase policies in the exchanges), that number will be 4 million to 5 million lower under the ACA than the number projected in the absence of the law.” (Emphasis added)
CBO is clearly projecting that net enrollment in the non-exchange individual market will decline (presumably because CBO believes that a portion of current individual market enrollees will seek subsidized replacement coverage in the exchanges as a result of the law). Therefore, here again, those 5 million projected enrollees do not represent a “gain” in coverage.
The 20 million figure sounds like a breakthrough, but the truth is the gains in coverage are not as strong as they are portrayed.