Was the Drop in Uninsured Almost All Medicaid Expansion?

Published January 9, 2015

One of the things I’ve been saying for a while is that when the dust clears and Obamacare is fully implemented, it’s probably going to look an awful lot like a massive Medicaid expansion with a modest boost in the individual health insurance market.

Yesterday I ran across recent Medicaid enrollment figures that suggests I’m probably not that far from the mark in my prediction. According to this report from the Centers for Medicare and Medicaid Services (CMS), about 9.7 million people have been added to the Medicaid rolls between October 2013 and October 2014.

Compare that then with this from an article in the New York Times, which I also cited here yesterday:

The Gallup-Healthways Well-Being Index found that the uninsured rate dropped 4.2 percentage points over the past year as the health law’s major coverage expansion went into effect. Other analysts have estimated that those gains translate to at least 10 million uninsured people getting coverage.

So, 9.7 million added to Medicaid, a total of 10 million removed from the number of uninsured.

I’ll go ahead and answer the rhetorical question I posed in the headline – no, it’s probably not fair to say that “almost all” of the decline in the number of uninsured is Medicaid expansion. These are different reports with different sources, so the numbers aren’t to be taken too precisely. Based on other reports regarding who is buying health insurance through the exchange, it seems likely that somewhere between two and three million previously uninsured bought and maintained health coverage through the exchange.

But the closeness of the two numbers, one an estimate and the other a fairly accurate head count, certainly bolsters the argument that Obamacare is Medicaid expansion with a side order of insurance bought on an exchange.