More Americans have health insurance: why Obamacare doesn't get full credit

The portion of Americans without health insurance has fallen amid the Obamacare registration drive, two polls find. But the largest source of gains in coverage has been employer-sponsored plans.

Two new polls are finding that the portion of Americans without health insurance has fallen amid the drive to sign people up under Obamacare. But precisely how many people are newly insured because of the law remains unclear.

A Gallup poll finds that the share of Americans who are uninsured fell from 17.1 percent late in 2013 to 15.6 percent during the first quarter of this year, as enrollment under the Affordable Care Act ramped up.

A separate survey by the RAND Corporation survey finds the ACA having what appears to be a much larger impact. The poll finds that the share of adults (ages 18 to 64) who lack insurance fell from 20.5 percent in 2013 to 15.8 percent as of late March.

The RAND figure suggests a much bigger Obamacare effect on insurance coverage – a swing of 4.7 percentage points in recent months compared with 1.7 percentage points in the Gallup poll.

That total is significant, because the RAND survey implies that the health-care reforms may be bringing the ranks of uninsured down by about the same percentage as had been forecast early this year by the nonpartisan Congressional Budget Office.

The CBO estimated that the Affordable Care Act would prompt 13 million Americans to become newly insured in 2014. That comes out to 4.75 percent of the 274 million non-elderly Americans, essentially matching the gains observed by RAND.

CBO forecasts aren’t make-or-break benchmarks of success, but many policy wonks view them as important. If the actual results were to fall far behind those estimates, the view that Obamacare is failing to match its aspirations would gain credence.

The Obama administration did a kind of victory dance last week in announcing that enrollment on the law’s new marketplaces reached 7.1 million Americans by March 31, essentially matching early projections made by the CBO.

But that number is preliminary, and it’s not a gauge of how many Americans have moved from the camp of “uninsured” to “insured.” Many of those 7 million already had insurance.

The polls offer some potentially significant clues to the bigger picture. And they come at an important moment, just after the close of a six-month window for individuals to sign up for Obamacare coverage.

The gap between the Gallup results and the RAND results may not be as big as it appears on the surface.

The RAND survey captures the more recent state-of-play in March, while the Gallup poll spanned from January through March – thus capturing a period prior to the final surge of Obamacare enrollment.

Gallup says the share of uninsured among its polling respondents was dropping as the March 31 deadline neared, reaching 14.5 percent in the final two weeks of the month. Using that number, the Gallup survey finds the share of uninsured adults is down by 2.6 percentage points since late last year, versus the 4.7 percentage points seen by RAND.

Then there’s the “margin of error” inherent in polling, which means that a totally accurate sample of Americans could look a little different than either of these polls.

Also of note: The two polls differ in whom they count and omit. Both polls focus on asking adults whether they have insurance. Neither counts children. The RAND survey also omits Americans of Medicare age (65 and up), which explains why its results show a higher share of Americans as “uninsured” back in 2013.

If the Gallup poll omitted seniors, that would tend to push up its measure of Obamacare’s impact on coverage. (It would find similar numbers of people becoming newly insured, but out of a smaller overall pool – excluding people on Medicare.)

Some other insights from the polls:

• Gallup found that young people (age 25 to 34) are still the most likely age group to be uninsured. The law’s architects envisioned this younger group as being especially important enrollees, because insurers can cover them at lower cost than older enrollees. But the poll found this group gained coverage in recent months only at the same pace as people 35 to 64.

• Some of the progress in insurance coverage probably stems from overall economic conditions or other factors unrelated to Obamacare. A surprise finding from RAND is that the largest source of the gains in new insurance coverage has been growth in employer-sponsored insurance, not among people shopping the Obamacare marketplaces or enrolling in Medicaid. “Some of these newly insured individuals may have taken up an employer plan as a result of the incentive created by the individual mandate; others may have newly found a job,” RAND researchers Katherine Grace Carman and Christine Eibner write in a report on the poll.

• Among those buying on the Obamacare exchanges, the RAND analysts said, “Our estimates suggest that only about one-third of new marketplace enrollees were previously uninsured.” That’s about 1.4 million out of 3.9 million enrollees counted in their poll. Although “this seems relatively low, it is slightly higher than findings reported earlier by McKinsey & Company,” they say.

• The RAND researchers say their poll implies that the ranks of the uninsured stand at about 31.4 million American adults. Some 7.2 million uninsured people got employer coverage, 3.6 million got Medicaid. Smaller numbers of people got other forms of insurance, while all these gains were offset somewhat by people losing coverage. When all the changes are netted out, about 9.3 million fewer adults are uninsured now than last year, they estimate.