7 million thanks to Obamacare?

“Thanks to the Affordable Care Act, more than 7 million Americans have signed up for private health coverage.”

—the White House, April 2014 on the whitehouse.gov website

 

Overview

The White House generously doles out undeserved credit to itself.

The Facts

The White House website has a menu option for exploring the administration’s stance on issues.  Clicking the “Health Care” button on the issues menu takes the browser to a page about the Affordable Care Act, the health care reform legislation passed in early 2010.  The page greets the visitor with “Thanks to the Affordable Care Act, more than 7 million Americans have signed up for private health coverage.”

We explored the menu below the headline but found no explanation of the 7 million figure.

Failing in that approach, we explored the website domain for an explanation.  We came up with an April 1 blog entry by Lindsay Holst:

Today, the White House announced that more than 7 million Americans signed up for affordable health care through the Health Insurance Marketplace during the Affordable Care Act’s open enrollment period, which ended on March 31.

The number, initially announced during Press Secretary Jay Carney’s briefing, means that millions of Americans across the country now have access to quality, affordable care.

 

A graphic embedded in Holst’s post helps confirm its relationship to the claim we’re investigating.

The White House website continues to use the claim prominently on its health care policy page.

Analyzing the Rhetoric

The White House rhetoric conflates two different things.  The ACA was passed to reduce the number of uninsured Americans, partly by expanding Medicaid and partly by subsidizing private insurance.  The bill also threatens penalties on those who do not obtain a minimum level of insurance.  The White House conflates its goal of reducing the number of uninsured Americans with the number of persons obtaining insurance through government health care exchanges.

What Difference Does It Make?

If the ACA reduced the number of uninsured Americans by 7 million signing up for private insurance, that would have to count as some type of success.  The goal was to reduce the number of uninsured Americans, partly through subsidized private insurance, and signing up 7 million for private insurance represents real progress toward that goal.  Or does it?

The administration’s 7.1 million April figure for private insurance signups through an exchange does not serve to show a net gain in people obtaining private insurance.  Many people with private insurance had their policies cancelled as higher standards imposed by the ACA kicked in.  Many of those ended up purchasing insurance through an exchange, and were likely to continue to receive insurance through the individual market regardless of the ACA.  In short, hundreds of thousands if not millions of the touted 7 million don’t have any cause to thank the ACA for having private insurance.  Some percentage of the total may have reason to thank the ACA for lowering their insurance premiums through subsidies, but that’s a different issue.

RAND Corporation conducted a study estimating changes in health care coverage as of March 2014, just before the administration’s announcement of over 7 million private insurance signups.  It estimated 1.4 million of exchange signups were previously uninsured.  At the time, that represented about one-third of the total exchange signups.  If the late surge in signups raised that percentage to 50 percent the White House exaggerates its achievement by roughly 100 percent.  We won’t know the truth for sure until the administration completely releases the necessary data, including the updated number of signups.

The administration has reason to take credit for lowering the number of uninsured Americans, though the cost of the achievement may remove much of the glory.  But the 7 million figure, particularly when the White House first published it, represents a big exaggeration if understood as a reduction of the number of uninsured.  The ACA deserves no special credit for simply channeling private insurance purchases through government-run exchanges, yet a large share of the White House’s 7 million happened for exactly that reason.

Is it possible the White House doesn’t know this?  It’s hard to believe, so we think the 7 million claim was probably crafted with an intent to deceive.

The CBO’s Estimate of 7 Million Exchange Signups

The White House’s use of the 7 million figure ties into the Congressional Budget Office’s estimates of the number of people who would get insurance through the exchanges. The administration adopted the CBO’s number as a measure of the success of the government marketplaces. But the CBO’s figure was plainly intended as a reduction in the number of uninsured. Just as plainly, the 7 million figure as used by the White House does not represent a net number of people going from no insurance to private insurance through the exchange system.

Again, it’s hard to believe the White House failed to recognize the difference between the CBO’s claim and its own claim of 7 million exchange signups.

Summary

“Thanks to the Affordable Care Act, more than 7 million Americans have signed up for private health coverage.”

Using charitable interpretation to make the White House statement true makes the statement incredibly cynical and fatuous.  Fatuous statements fail the test of reason, leaving us to conclude the White House used a wrong and strongly exaggerated figure.  Many of the 7 million the White House boasts would have purchased private health insurance regardless of the ACA, so the bill doesn’t deserve the credit the White House claims for it.  The wording of the claim encourages the audience to think 7 million left the ranks of the uninsured into private insurance thanks to the ACA.  The number is probably closer to 3 million, extrapolating from the RAND Corporation’s research.

Update June 26, 2014:  

Kaiser Family Foundation has completed a survey that updates estimates of those newly insured through the purchase of private insurance through a government insurance exchange.  The KFF survey found about 57 percent of those buying private insurance through an exchange were previously uninsured.  Using that figure, when the White House announced 7 million signups the number of those previously uninsured was about 4 million.  If we use the 57 percent figure on the approximately 8 million the administration says have now purchased private insurance through an exchange that number jumps to 4.56 million—still closer to 3 million than to 7 million.

References

“Get the Facts Straight on Health Reform.” The White House. The White House, Apr. 2014. Web. 10 June 2014.

Internet Archive version of the above from April 2014

Carman, Katherine Grace, and Christine Eibner. “Survey Estimates Net Gain of 9.3 Million American Adults with Health Insurance.” RAND Blog. RAND Corporation, 08 Apr. 2014. Web. 09 June 2014.

Carman, Katherine Grace, and Christine Eibner. “Changes in Health Insurance Enrollment Since 2013.” Rand.org. RAND Corporation, Apr. 2014. Web. 09 June 2014.

Goldstein, Amy, and Juliet Eilperin. “More than 7 Million Have Enrolled under Affordable Care Act, White House Says​.” Washington Post. The Washington Post, 02 Apr. 2014. Web. 09 June 2014.

“Table 1. CBO’s May 2013 Estimate of the Effects of the Affordable Care Act on Health Insurance Coverage.” CBO.gov. Congressional Budget Office, Apr. 2013. Web. 10 June 2014.

Haberkorn, Jennifer. “Kathleen Sebelius: Exchange Enrollment Goal Is 7 Million by End of March.” POLITICO. POLITICO LLC, 24 June 2013. Web. 10 June 2014.