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The U.S. uninsured rate continues to drop under Obamacare

gallup tracking poll 1st quarter 2015

Just wanted to quickly point out that the latest Gallup survey shows that the uninsured rate has dropped again, to 11.9% in the first quarter of 2015– the lowest it’s been since Gallup began tracking it in 2008. That 1% drop over the last quarter alone represents over 3 million people who gained coverage.

We were curious how opponents would respond to such clear evidence that Obamacare has, as promised, expanded coverage to millions of Americans. After all, conservative pundits and think tanks have spent the past few years predicting that the new law would have no effect on the uninsurance rate and that the only people getting coverage already had insurance.

Unsurprisingly, given how spectacularly wrong they were, many of these top conservative wonks and pundits have been pretty quiet about the falling uninsurance rate. However, we did find some weak attempts to dismiss it from their B team. 

No, Obamacare really is behind the drop in uninsurance rates

One of the sillier arguments we’ve heard is that something besides Obamacare may have caused the decline in uninsurance. For example, when Edmund Haislmaier, a senior fellow at the conservative Heritage Foundation, was asked to comment on the Gallup surveys, he told the Wall Street Journal, “It’s premature to say it’s ACA related.” New York Magazine’s Jonathan Chait had a great response:

Right, I mean, who can really say? Yes, there has been a sudden and extremely sharp plunge in the uninsured rates among the populations eligible for coverage under Obamacare that begins at the exact time Obamacare took effect.

Kaiser Tracking Poll March 2015

But that could be anything. Survey error. People being excited about Republicans winning the midterm. Sunspots. You never know. Probably not the sudden availability of a major new federal health-care law enrolling millions of people.

Until now it was only supporters saying that Obamacare would work

A more common argument is that the drop in uninsurance rates is meaningless since the law says you have to get coverage or pay a penalty– of course more people will have coverage now. One of Matt Yglesisas’ readers on Vox.com put it this way: “If there was a law requiring people to wear hats, then the hatless rate would drop.”

That’s a little like saying Medicare is meaningless because it simply gives seniors coverage. (Or as Yglesias’ reader might put it: “If there was a law giving every senior a hat, then the rate of hatless seniors would drop.”) Also, the individual mandate is just a small part of Obamacare– there are also subsidies to make the coverage more affordable, new rules to ensure that people can actually access care with their coverage, and a Medicaid expansion for those who make too little to afford any premiums. These aspects of the law are much more likely responsible for the plummeting uninsurance rate, particularly since the penalty for not having insurance is much less than the cost of an insurance plan.

The simplest response though is one that Yglesias brings up: if conservatives really believed that “of course” Obamacare would lead to more people to gain coverage, then why did so many argue that it wouldn’t?

The decline in the uninsurance rate is significant

Chris Conover, a researcher at Duke’s Center for Health Policy & Inequalities Research and scholar with the conservative American Enterprise Institute, at least admits that Obamacare did cause uninsurance rates to drop, but argues that the size of the drop isn’t all that impressive. After all, he writes, the uninsurance rate fell twice as much under Eisenhower and five times as much under Truman, and neither of them passed a major health reform bill.

However, comparing the relative decrease in uninsurance rates under each president is ridiculous since the starting points were so vastly different. According to Conover, the uninsurance rate declined 16.3% under Eisenhower, from 41.5% to 25.2%. Using his own data, the uninsurance rate at the start of Obama’s presidency was 15.4%– it’s mathematically impossible for Obama to decrease it as much as Ike, since to do so he’d have to get the number of Americans without coverage to less than zero.

It’s also worth looking at why the insurance rates declined so much under the earlier presidents. Conover claims “This extraordinary expansion of coverage powerfully illustrates what can happen when government lets markets do most of the heavy lifting.” What Conover leaves out is that while relying on the market to expand coverage worked in the early days of health insurance, (Blue Cross and Blue Shield, two of the earliest health insurance networks, weren’t formed until 1939), that expansion stalled out under Eisenhower, leaving a quarter of the country without coverage. The only major expansions of coverage since then have been major government interventions: Medicare under LBJ and now Obamacare. You can see it in Conover’s own data:

uninsured risk timeline

To put Obamacare’s reduction of the uninsurance rate into perspective, let’s compare it to something a bit more recent. There was a huge outcry over people losing their plans as a result of the new law, but a study from the Urban Institute found that the total was fewer than a million policies were actually canceled. Meanwhile, that 6% point reduction in the uninsurance rate since the passage of Obamacare means that at least 16.4 million people without insurance now have coverage- an amount that is expected to double over the next few years.

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