As we observed earlier this week, one of the obsessions of opponents of the Affordable Care Act is the question of how many enrollees in Obamacare health plans already had insurance. The goal is to knock down the latest enrollment numbers by suggesting that most of the 7.1 million people enrolled through the individual insurance exchanges just moved from one insurance plan to another in a waste of time and effort.

The real figure probably won’t be known for weeks, even months. But researchers at the Urban Institute’s Health Policy Center have weighed in with their own estimate. They’re figuring that the ACA has reduced the number of uninsured Americans by 5.4 million from the first quarter of 2013 through early March this year.

Their estimate is based on data from their March 2014 Health Reform Marketing Survey, which consists of public polling. Their finding is that the uninsurance rate for adults ages 18–64 was 15.2% for the nation in early March, a decline of 2.7 percentage points since September 2013, just before open enrollment on the exchanges began Oct. 1.

“This represents a gain in coverage for about 5.4 million adults,” they write.


Although the Urban Institute figures aren’t keyed to the enrollment figures, it’s worth observing that if all those newly insureds were among those who signed up on the individual exchanges, that would mean that of the 7.1 million enrollees, 77% were previously uninsured.

The researchers say, however, that their figures include people who will receive their insurance from Medicaid, which was expanded in about half the states. (The others refused to take up the federal government’s offer to pick up 90% to 100% of the tab.)

In Medicaid-expanding states, the uninsured rate fell by an average of 4% and is now an average 12.4%, according to the survey; in the others, it fell by an average of only 1.5% and is stuck at an average 18%. Thus does ideological opposition to the ACA by Republican office-holders in non-expanding states make suckers of their citizens.

The Urban Institute says its figures probably understate the decline in the uninsured ratio for two reasons. First, it doesn’t count the late-March surge of enrollments that brought the exchange total to 7.1 million; second, it doesn’t measure the effect of other ACA provisions, including one allowing adults up to the age of 26 to stay on their parent’s health plans.


That said, it’s proper to observe that the debate over how many people were previously insured is something of a red herring. The ACA had several goals -- to impose national consumer protection standards on the health insurance industry by eliminating exclusions for preexisting conditions, among other things; slow the growth of healthcare costs; reduce the number of underinsureds (those who were forced because of costs to buy plans with limited coverage); and finally to reduce the number of uninsured people.

All those goals, not just the last, have been advanced by the ACA. In addition, it has always been clear that the act is a multi-year project. Judging its success or failure by this one metric of how many uninsured people were signed up in year one doesn’t tell us anything about how it will change healthcare coverage in the U.S. over time.