HHS Makes 14.1 Million Uninsured People Magically Disappear

Competing with all the election news and troubles in the Middle East last week, it didn’t take long for 2016 ObamaCare enrollment projections to get lost in the noise.

Last Thursday, Department of Health and Human Services (HHS) Secretary Sylvia Burwell released a news brief in which, buried amongst dozens of facts and figures, she released the less than stellar enrollment projections for the forthcoming opening of the ObamaCare exchanges.

 

“Finally, there are those who will come from the 10.5 million eligible uninsured. We expect to draw in about 2.8 million to 3.9 million of those individuals.” 

HHS expects that somewhere between 2.8 to 3.9 million uninsured individuals will purchase a healthcare plan through the state and federal healthcare exchange this coming open enrollment period.  While this figure is significantly lower than the 6 million originally projected when the law was passed, considering the abysmal turnout by the uninsured during the first two open enrollment periods, this is actually is a pretty lofty goal.  But I will save my amateur analysis of what I believe is Burwell’s unachievable enrollment projections for my next blog.  For now, there is a much more sinister figure reported in her news brief that needs to be brought to light.

Where Did This Number Come From?

10.5 million eligible uninsured, did I read that right?  Seriously, where did this number come from?  I’m pretty in tune to all the facts and figures related to ObamaCare enrollment and 10.5 million is not a number that I am familiar with.  But that’s okay, since it represents the number of uninsured eligible for Marketplace coverage, it should be simple to validate, all we need is a starting point and the number of long term uninsured that have purchased and maintain a qualified healthcare plan through one of the state and federal healthcare exchanges to reduce it by.

First, the starting point.  In 2009 the US Census Bureau reported that 48 million Americans lacked health insurance.  Of those 48 million, 29 to 30 million were eligible for Marketplace coverage.  The balance, of course, would be those qualified for Medicaid. 

Next, the number of long term uninsured that have purchased and maintained a qualified healthcare plan.  As no department of the Obama Administration reports this number specifically, we are going to have to do the leg work ourselves.  Fortunately HHS does provide us with enough information to do so.

From the HHS ASPE Data Point report released on September 22, 17.6 million uninsured individual are reported to have gained health insurance coverage since the implementation of the Individual Mandate on January 1, 2014.  This figure includes all forms of individual healthcare insurance including on-exchange purchases, off-exchange purchases and Medicaid.  For roughly the same period, the Centers for Medicare & Medicaid Services (CMS) reported that there were 13.2 million individuals enrolled for Medicaid as a direct result of the Medicaid Expansion.  When we reduce the total number of those who have gained healthcare insurance by the number who have gained coverage through the Medicaid expansion we are left with 4.4 million {4.4 million is a significant overstatement of the actual on-exchange enrollment which I will address in my next blog}. 

So, if there were around 29 million in the pool of the uninsured eligible for Marketplace coverage at the start and we reduced that number by the 4.4 million uninsured who purchased a healthcare plan during the first two open enrollment periods then the remaining pool of uninsured should be roughly 24.6 million.  Wow, that’s a far cry from the 10.5 million HHS is reporting. Somewhere, somehow HHS made 14.1 million uninsured people magically disappear!


Where did the 14.1 Million Missing Uninsured Disappear To?

The better question is, where did HHS come up with 10.5 million as the number of uninsured eligible for Marketplace coverage?  And I have that answer!

Sadly, but hardly surprising, HHS willfully mislead the American people.  HHS arrived at their 10.5 million figure simply by reducing the original pool number of 28.1 million¹ by the 17.6 million reported to have gained healthcare coverage in the HHS ASPE Data Point report.

Likely at the direction of the White House, since the day the healthcare exchanges first opened, HHS has routinely misrepresented Marketplace enrollment by including Medicaid expansion participants in to the count.  Less than 25% of the 17.6 million HHS used to derive the 10.5 million figure actually makes up enrollment through the healthcare exchange.
¹ The size of the pool varies slightly depending on which source is use.  I chose to use the US Census Bureau figure as it is easily verifiable, HHS uses CBO data which also varies from one report to the next.


Why Would They Do Such a Thing?

Tell me, what looks better to the people, reducing the number of uninsured from 28 million to 24 million or reducing the number of uninsured from 28 million to 10.5 million?  Reporting a greater reduced pool of uninsured helps the Obama Administration play down the failure of the Individual Mandate.  The Obama Administration started doing this the first day the healthcare exchanges opened and has been doing so ever since.  And what has the media done?  The media has given the administration a fee pass on this gross misreporting of the numbers.

The faux 10.5 million figure also helps to improve how participation of the uninsured looks.  Let’s assume, for example, that HHS meets their projected goal of 4.4 million uninsured enrolling through the healthcare exchanges.  This would equate to the enrollment of 1 out of every 2.3 of those eligible to purchase a healthcare plan as opposed to 1 out of every 5.7 of those eligible to purchase a healthcare plan if compared to the actual uninsured pool of 25 million.


ObamaCare is without a doubt in serious trouble and the intentional misrepresentation we see here is affirmation of that.  And with guaranteed premium increases coming for 2016, we could be looking at a net negative enrollment this coming open enrollment period.

How many have actually purchased and continue to retain a qualified healthcare plan from the pool of 29 million eligible to participate on the Marketplace has not been answered definitively and remains one of the best kept secrets of the Obama Administration.  But as more enrollment information finds its way to the public a better picture of past, present and future enrollment can be painted, which is the topic of my next blog.