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A Project of The Annenberg Public Policy Center

Reid Overstates Reduction in Uninsured

Senate Majority Leader Harry Reid incorrectly claimed that 9 million Americans “have health care that didn’t have it before” because of the Affordable Care Act. That figure includes an unknown number who previously had insurance but switched to a policy sold through the exchanges, plus an unknown number of Medicaid recipients who renewed their coverage.

Reid made the statement on CBS’ “Face the Nation” on Jan. 5, saying:

Reid, Jan. 5: [R]ight now, as we speak, there are 9 million Americans … who have health care that didn’t have it before. We have, as you know, we have 3 million Medicare [Medicaid]. We have 3 million on their policies because they haven’t reached, they haven’t reached age 26. And we’ll have more than 2 million. They’re coming.

The 9 million figure includes three categories of Americans: 2.1 million who have selected plans on the federal or state insurance marketplaces, or exchanges; 3.9 million who were determined to be eligible for Medicaid and the Children’s Health Insurance Program (higher than the 3 million figure Reid used); and an estimated 3.1 million young adults under the age of 26 who were able to join their parents’ policies as a result of the ACA.

But it’s wrong to assume, as Reid does, that all of those people were previously uninsured.

Let’s start with those who were uninsured. Some may consider the inclusion of the 3.1 million young adults an attempt to puff up the numbers after a slow, glitch-filled and, by any standard, unsuccessful launch of the exchanges last fall. After all, this provision of the law was implemented in September 2010. But this is the one estimate that’s made up exclusively of those gaining insurance. The estimate comes from the Department of Health and Human Services, which said in a June 2012 press release that the figure was based on the National Health Interview Survey conducted by the National Center for Health Statistics, which found an increase in the percentage of young adults (age 19 to 25) with insurance between September 2010 and December 2011. (Some among this estimate may well have gained coverage in another manner — other than being added to their parents’ plans — but the number does represent an increase in the insured in an age group directly affected by the law at the time.)

It’s the other two categories that include folks who did have health coverage before, contrary to Reid’s remarks.

The 2.1 million people who selected exchange plans include some who had insurance but switched to these marketplace plans, such as those whose insurers canceled specific plans or even pulled out of the individual insurance market altogether. And, as Washington Post Fact Checker Glenn Kessler pointed out, it even includes Reid, who, like other previously insured members of Congress are required to get their coverage through the exchanges, rather than the Federal Employees Health Benefits Program, as they did before.

Then there’s the Medicaid estimate. Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services, announced on Dec. 31 that 3.9 million “learned they’re eligible for coverage through Medicaid and the Children’s Health Insurance Program (CHIP) in October and November.” She noted: “These numbers include new eligibility determinations and some Medicaid and CHIP renewals.”

So, some portion of that 3.9 million — a figure that comes from state reports — includes Americans who already had Medicaid or CHIP and are simply renewing, and it could include those who had insurance through another source and are now eligible for Medicaid. CMS doesn’t have such a breakdown on these Medicaid-eligible folks. The figure also includes those who were previously eligible for Medicaid (before the ACA) and are now signing up. Some of those previously eligible folks may not have been influenced by the law; others may have been prompted to seek coverage because of the individual mandate, or because they’ve heard so much about the health care law.

One last note: Americans buying their own insurance don’t have to go through the exchanges; they can buy directly from an insurance carrier. It’s possible some of the previously uninsured have done so, but we know of no estimate for that.

What we do know is that it’s incorrect to say, as Reid did, that the 9 million figure represents “Americans who have health care that didn’t have it before.”

The nonpartisan Congressional Budget Office has estimated that in 2014, due to the Affordable Care Act, the number of uninsured would decline by 14 million, with 7 million joining the exchanges, 9 million gaining Medicaid and CHIP, and 2 million fewer Americans getting coverage through the individual market. It remains to be seen how closely reality will track with those estimates.

Update, Feb. 6: A Feb. 5 report from Avalere Health, a health care industry consulting firm, estimates that most of the Medicaid and CHIP determinations were not new enrollees due to the law. The report comes after CMS released updated figures, saying that 6.3 million had been determined eligible for the programs from October through December. Avalere estimates that between 1.1 million to 1.8 million enrolled because of the health care law. The firm compared the October through December Medicaid and CHIP numbers from CMS to the average monthly number of applications in July through September 2013.

— Lori Robertson