How Many of Obamacare’s New Enrollees Were Uninsured Last Year? Why It Doesn’t Matter

Charles Gaba, the enrollment guru who has been tracking Obamacare sign-ups since October, now estimates that by April 15, some 17 million Americans will have purchased their own insurance policies either in the Obamacare Exchanges (8 million) or off-Exchange (9 million)

But how many of them were uninsured and how many were simply replacing policies that Obamacare had forced insurers to cancel?  This is the question conservatives ask.  After all they argue, if most of these folks already had coverage, we have just wasted a great deal of time and money moving them from a policy they chose to one that President Obama prefers.

There are two answers to their question. The first is that while we don’t have an exact number as to how many of the new enrollees were uninsured, we do know that, thanks to Obamcare,  the percent of Americans who are “going naked” has declined. New Gallup data shows that the uninsured rate fell from 18.1% in the third quarter of 2013 to 15.6% in the first quarter of 2014.

That said, Gaba offers a second, even better, answer: “It doesn’t really matter.” 

I agree. As he explains:

“It doesn’t matter because every one of those new policieswhether on-exchange or off-exchange; whether it went to someone who didn’t have insurance before, someone who had their old policy cancelled or went to someone who voluntarily made the switch to a new one…which  . . is a LOT of people, by the way…is still a fully ACA-compliant, full-coverage healthcare plan.”

Gaba points out that “the primary point” of his website ( “is to track how many people are now enrolled in a “QHP certified” plan regardless of whether they had insurance before or not. Some moved from no plan at all to a QHP. Others moved from a ‘junk’ policy to a QHP (some have argued that there aren’t that many of these, but there were still a lot of them). Still others yet (myself included) have moved from a decent plan to a QHP. . . . The point is, they’re all ACA QHPs now.” [his emphasis]

This is critical to understanding the purpose of health care reform. From the beginning the goal of the Patient Protection and Affordable Care Act (PPACA) was not simply to insure the uninsured, but to protect the under-insured by making certain that everyone has comprehensive coverage.  Whether a carrier is peddling policies in a state marketplace or off-exchange all plans now must comply with the ACA’s rules by:

–covering the ten essential benefits

–offering free preventive care, and

–capping how much a patient can be asked to pay out-of-pocket.

In addition, carriers can no longer discriminate against customers suffering from pre-existing conditions by charging them exorbitant premiums, and they cannot set a limit on how much the insurer will pay out, over the course of a year or a lifetime.

The second goal of the Patient Protection and Affordable Care Act is to make sure that the price of such high quality insurance is not beyond reach. Government subsidies help low-income and median-income families, but the only way to make sure that everyone else can afford policies that meet the ACA’s high standards is by asking all of us to share in the cost.

This is why the ACA mandates that everyone purchase insurance. When more people pay into the risk pool, the costs decline for everyone. It is only then that universal coverage becomes possible


7 thoughts on “How Many of Obamacare’s New Enrollees Were Uninsured Last Year? Why It Doesn’t Matter

  1. Maggie:

    Good points, as usual. Last I checked the U.S. was 33rd out of 34 OECD countries in the percentage of citizens with health coverage of some type, behind Mexico but ahead of Chile. Perhaps now we will move up the ladder a bit. Unfortunately, the opposition never tires in their efforts to ensure that fewer people are covered and that fewer people have the many consumer protections in the ACA.

    You should write a book about the history of the opposition to the ACA, including all of the lies and deceptions and all of the efforts to undermine or sabotage the law. There is a good article at the New Republic website, “Hannitys on the Bench,” which talks about some of the tortured logic used by judges related to challenges to the ACA. Here is one gem from D.C. Circuit Judge Raymond Randolph:

    “[I]t was widely known that unless the states set up an exchange they weren’t going to get subsidies for their citizens.”

    Incredible. No, Judge Randolph, it was actually widely known that subsidies would be available whether the exchanges were run by the states or by the federal government. It’s amazing what can happen when wishful thinking overpowers rational thought.

  2. Jon—

    How very true.

    People tend to believe what they want to believe–and unfortunately, this includes judges.

    A book about opposition to the ACA is not a bad idea.

    Ideally it would come out in 3 or 4 years–when most people realize how they– and/or people they know–have benefited from the ACA.

    And it could be wickedly funny– just quoting all of the ridiculous things that have been said.

  3. Bruce—

    Thanks much, but it took me three years to write each of my last books. . .

    On the other hand it does strike me that I could cull much of the information from HealthBeat posts that I wrote as I followed the run-up to passage from 2007 to 2010–and
    then the continuing battle, even after the legislation passed–up until the present day.

    I would also want to go back and interview some people involved in the battle. For instance, people who were on Ted Kennedy’s staff, Pelosi’s staff, Harry Reid’s staff as well as Pelosi and Reid.

    If I could find a sponsor (someone who could pay me while writing it) I could probably publish the book online before the election.

    (Working title: The Bloody Battle for Health Care Reform)_

  4. It is amazing how main stream news media continues to run stories full of inacuracies about the ACA and very few stories about how it is helping healthcare in this country.
    No wonder people are confused and mislead by people like Ted Cruz