Medicaid and Obamacare: The Data Donut Hole



Josh Marshall wants people to believe that approximately 10 million individuals have health coverage because of the Affordable Care Act. Writing for Talking Points Memo, Marshall says that this number is reached by the number of signups on for insurance: 2.1 million. To this, he adds an estimated 4.3 million people who enrolled in Medicaid and the Children’s Health Insurance Program. Finally he includes the 3.1 million young people who have stayed on their parents’ insurance plans.

His totals get him to 9.5 million, which he then rounds up to account for incomplete and non-updated data. Ezra Klein of the Washington Post takes issue with some but not all of this data. He gives credit to the number of signups and to the young people who stayed on their parents’ insurance.

The data about young people retaining their parents’ insurance is reliable, but it is impossible to know how many would not have pursued health coverage had they not been able to stay on their parents’ plan. This figure would be nearly impossible to track — the program is incredibly popular and has grown since it was implemented in 2010.

What Klein does provide a discussion of is the difficulty in knowing how many people have enrolled for Medicaid. Klein cites a 4.4 million figure for Medicaid enrollees; Marshall uses 4.3 million — based on Charles Gaba’s ongoing tracking of enrollment data for Obamacare — as a starting point. Marshall points out that some people are using a 3.9 million figure but disposes of it, since it does not include December data.

But it is an important number, because it comes from a report on Medicaid and the Children’s Health Insurance Program enrollment in October and November by the Centers for Medicare and Medicaid Services (or CMS). Although the report only runs through November 30, there are caveats that need to be considered when evaluating Medicaid and CHIP data.

First is that the number of people who signed up for Medicaid because of Obamacare has not been separated from the number of people who would have signed up regardless. (Klein mentions this issue as well). CMS explicitly points this out before diving into the numbers.

“Medicaid and CHIP are longstanding programs that were already enrolling eligible individuals into coverage prior to the Marketplace open enrollment period, and also cover people beyond those who might be newly eligible for Medicaid under the new adult group,” the agency says. “Therefore, this report necessarily captures data beyond the newly eligible individuals in states that have expanded coverage.”

The numbers cited are only preliminary data — only 46 states plus the District of Columbia had sent November enrollment, so the totals could still increase. In November, across all states, CMS says approximately 1.7 million individuals were deemed eligible for Medicaid and CHIP.

In states that expanded coverage, 890,335 applications were received. Compared to what CMS called “Pre-ACA Monthly Average,” which took application numbers from July through September of last year, applications decreased by 4.2 percent. For those states not expanding coverage, 846,474 applications were submitted to the agencies. This was an even sharper decline from the pre-Affordable Care Act data.

Overall, in the states submitting application data, there were 10.2 percent fewer applications in November than the averages from July through September. Although the drop was larger in states that had not expanded Medicaid coverage, the total of “New Determinations,” those people eligible for Medicaid and CHIP, was higher.

For states not expanding, a combined 956,750 were eligible for the programs; in states that did expand, the figure was 784,261. These numbers are not meant to disprove the need for Medicaid expansion or point to the failure of a program. The purpose instead is to show the paradoxes and difficulty in unwinding Medicaid enrollment.

Clearer data are therefore needed from the federal and state governments in order to understand how Medicaid as a part of Obamacare is functioning.

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