Obamacare is much in the news again these days what with the Supreme Court set to rule on the King vs. Burwell case later this summer. That ruling should determine whether or not the federal government can subsidize insurance purchases through the federal exchanges. Plaintiffs in the case argue that a plain reading of the law says that only policies purchased through state-run exchanges can be subsidized, and that this was an intentional “carrot” put into the policy to lure states into starting their own exchanges.
But most states did not create their own exchanges, and the feds have decided that they can subsidize those policies as well despite what the law says.
Yet, as that debate rages, you have to wonder…what exactly has Obamacare accomplished? Aside from costing millions their existing coverage, turning health insurance purchases into a bureaucratic nightmare, and accelerating the cost of health insurance?
Supposedly the law was all about expanding coverage to the uninsured, yet there doesn’t seem to be any really clear indication of how successful the law has been in doing that. According to national data the number of uninsured Americans has declined by 8 million since Obamacare became law, and while that sounds like a lot it leaves some 37.2 million uninsured according to data from the National Center for Health Statistics published by the CDC.
Also, of that 8 million number, approximately 7 million found coverage through the expansion of the Medicaid program which was a part of Obamacare. Which leaves us with just roughly 1 million people newly insured through private, non-government insurance policies.
Here in North Dakota the impact on the uninsured issue is completely opaque. In 2013 the Obama administration claimed that there were over 68,000 uninsured North Dakotans who would qualify for insurance coverage under Obamacare, either through the insurance exchanges or through the state’s Medicaid expansion. Yet through March of this year only 16,222 people in North Dakota had purchased and effectuated (meaning paid for their first month) health insurance in the state according to the Department of Health and Human Services.
According to LuWanna Lawrence, spokeswoman for North Dakota’s Department of Human Services, there were 18,505 who had signed up for health insurance through the Medicaid expansion, again through March.
Even if we assume that every single one of these North Dakotans who got insurance either through the Obamacare exchange or Medicaid were previously uninsured – we shouldn’t because many had insurance previously – we’re talking about 34,727 people. That’s barely over half of the 68,403 people who were uninsured and eligible for coverage according to the Obama administration’s own numbers.
If the goal was to insure the uninsured, a 50 percent success rate (again, if we assume all the enrollees were previously uninsured) is no success at all. But we can’t make that judgment, because we have no idea how many of those people were previously uninsured. And there’s no real way of knowing.
I asked Lawrence yesterday if they tracked how many of the Medicaid enrollees were previously insured. “This information is not a criteria for Medicaid eligibility,” she told me in an email. And the Obama administration isn’t releasing any figures for the federal exchange which North Dakota is participating in.
So the question is: “What has Obamacare accomplished in terms of insuring the previous uninsured in North Dakota?”
The answer: ¯_(ツ)_/¯
That’s disturbing given that the justification for what has been a painful and fraught national transition to Obamacare was insuring the uninsured.