Understanding ObamaCare’s Enrollment Numbers

ObamaCare enrollments can be looked at in a few ways: current Marketplace enrollments, current insured under the ACA, and total average insured for the calendar year.


ACAsignups.net does seem pretty great work when it comes to breaking down ACA enrollment numbers. Image from January 7th, 2014.

Depending on how we are looking at the numbers, and what other factors we take into account, the answer to, “how many people enrolled in ObamaCare” changes. For instance we can’t compare average enrollments in a year, to who is enrolled at a given point. To quote page 6 of the April estimates by the Congressional Budget Office (CBO) and Joint Committee on Taxation (JTC)

“…CBO and JCT’s estimate of 6 million people receiving such coverage in 2014 cannot be compared directly with the number of people who have enrolled through the exchanges as of any given date. The number of people who will have coverage through the exchanges in 2014 will not be known precisely until after the year has ended.”

In that same way we must always differentiate between Health Insurance Marketplace enrollments, enrollments which count Medicaid, enrollments that count state exchanges, total signups (not enrollments), enrollments due to ACA provisions, enrollments with plan drops for any reason, special enrollments outside of open enrollment, non-elderly versus total enrollments, and non-private coverage enrollments outside of open enrollment. And of course we need to look at who is calculating what and what methods they are using.

For instance the Gallup poll which shows the uninsured rate as 12.9% (and this is pretty accurate) uses a methodology that involves polling about 43,000 people over the phone (it’s not an actual uninsured rate, even the census calculates uninsured with polling).

Given all these complexities (not just with enrollment numbers, but with the law in general), we often find talking heads arguing apples and oranges (and sometimes coming to tears over it). However, by understanding how health insurance enrollment data really works and how ACA related provisions affect that, you’ll be able to differentiate between the enrollment number talking points and facts.

Let’s take a look at some quick facts and factors that will make enrollments make more sense.

How Health Insurance Enrollment Numbers Under the Affordable Care Act Work

At ObamaCareFacts.com we like to use bullet-points to explain complex situations. There is always a rabbit hole to jump down with health insurance and the ACA, so let’s look at some key bullet-points for a basic understanding of how enrollment numbers and uninsured rates really work.

  • The way the uninsured rate has been tracked over time doesn’t lend itself to compare new data with old data very well. You can see old census data since 2008, but it only stretches back so far. It is calculated differently now then it used to be.
  • As of 2014 calculating uninsured rates will be easier. This is because everyone must report if they have coverage or not on their 2015 taxes and beyond. That paired with Medicare, Medicaid, and CHIP (which have easy to track data) will mean simpler more standardized methods for calculating uninsured.
  • One of the smartest things you can read on enrollment data is the latest CBO report and other CBO reports in general (despite them focusing on budget). Their projections for what would happen in 2014 seem to be pretty much on point, that hints that we can take the rest of the report at face value. Since the CBO is non-partisan and fact based it’s a good read for all. Other helpful sites include HHS.Gov, and KFF.Org for official sites and ACASignups.net for an unofficial site. It’s strongly suggested that you don’t get your enrollment number facts solely from the media, as they often leave out key details.
  • The ACA contains many provisions that affect the uninsured rate of non-elderly Americans (we almost never are discussing Medicare uninsured rates, they are low). These include: Subsidized or unsubsidized coverage through the Health Insurance Marketplace HealthCare.Gov, subsidized or unsubsidized coverage through the state Marketplaces, the expansion of Medicaid and CHIP, young adults staying on their plan until 26, the expansion of work based coverage, the mandate to obtain coverage, and general woodworking effects (people who aren’t directly affected by a new provision, but enroll due to the increased attention to health insurance).
  • Given the above we have to distinguish between Marketplace enrollments and total enrollments due to ACA related provisions generally when discussing enrollment numbers.
  • We also need to consider those who drop their plan, had their plan cancelled, or lost coverage through work. Not everyone who loses coverage does so unwillingly, people quit their jobs because the ACA helps eliminates job lock due to health benefits, people with cancelled plans got other plans, and people will drop plans simply because they choose to switch to another plan. In other words, not every plan loss is inherently evil.
  • Now we have to distinguish between the timeframe in which we are talking about enrollments. If we pick any given calendar date only X amount of people will be enrolled in a plan.  If we look at total average enrollments for that calendar year, we will get a different number.
  • Often anti-ObamaCare talking points work like this: Take total plan losses from all ACA provisions, compare them to Federally Facilitated Marketplace (a fancy term for the Federal Marketplace HealthCare.Gov) only enrollments at a single point when enrollments are the lowest they have been all year, and then use that to reason, “ObamaCare isn’t working”. As you probably have guessed already, that involves some pretty fuzzy logic and is comparing apples to oranges.
  • On that same note we hear pro-ObamaCare talking points which disregard plan loss, and in a rather embarrassing incident, even include dental enrollments.
  • That being said, oddly, both side of the issue love to focus on Marketplace enrollments which gives everyone a narrow view of what is really going on in health insurance. Private Marketplace enrollments only make up a small percentage of the total insured (about 5% pre ACA). Even of the currently uninsured, more will qualify for a employer-sponsored plan, or in Medicaid and CHIP, than the Marketplace.
  • The famous “8 million” number was marketplace enrollments (state and federal), but not enrollments from any other ACA provision. Nor did it account plan loss. It wasn’t an average for the year, it was a number at the end of open enrollment. It also didn’t account for those who lost their plan or wouldn’t pay. Only 4.5 million of those renewed their plan for 2015. Actual total covered under the ACA, with plan drops included, was about 15 million at that same point. Again this was not an average. Consider by the end of 2015 routers showed a 12.9% uninsured rate down from 13.4% at the end of open enrollment last year, we can assume the total insured rate increased slightly over the year.

Given all the above information here are a few quick enrollment facts:

  • About 4.7 million people had their plan cancelled in 2013.
  • About 8 million were enrolled in a Marketplace plan by the end of open enrollment 2014. Another 8 million or so were Enrolled in Medicaid. About 6 million in CHIP. 2.6 million under 26. And even more outside the marketplace. A total, with cancellations counted of about 15 million.
  • During the year people didn’t pay their premiums (many didn’t even pay their first month).
  • Throughout the year people enrolled in special enrollment, switched plans, and dropped plans.
  • About 4.5 renewed their marketplace plan by Dec 19th, 2014.

As of the end of the start of January of 2015 the uninsured rate is about 12.9% and 6.6 million are enrolled in HealthCare.Gov. About a 1,000,000 more are enrolled in state exchanges. We don’t have exact numbers on employer coverage or Medicaid and CHIP at the moment. But you can find state-by-state breakdowns of more data on HHS.

See our ObamaCare Enrollment numbers page for more details. If you find a statistic that is un-cited (i.e. not clickable), we may be drawing it from our breakdown of enrollment numbers and uninsured rates, or from a report linked on this page. For instance all Marketplace enrollment data can be found on the HHS blog, while our breakdown of plan cancellations can be found on our enrollments page.

Author: Thomas DeMichele

Thomas DeMichele is the head writer and founder of ObamaCareFacts.com, FactsOnMedicare.com, and other websites. He has been in the health insurance and healthcare information field since 2012. ObamaCareFacts.com is a...

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Everyone should have healthcare, who knows how that should be paid. Some article I read said about 30 million people had their insurance plans canceled due to ACA as their plan did not meet ACA guidelines (note that some people do not need all the benefits outlined under ACA), and some number more (I don’t have a figure) lost their plan when their employer decided it was cheaper to pay the ACA penalty than to pay for employee healthcare. What happened to those people? Did they enroll in the ACA program? Are the enrollment numbers additional people enrolled in the ACA program year after year or are they the total enrolled for any given year? How many people became insured under the ACA program that would not otherwise have been insured and what was the cost of that?

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