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Obamacare’s Unlikely Coverage Goal
The country was promised a net increase of at least 14 million insured Americans in 2014.

An Affordable Care Act navigator (at right) works with customers.

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James C. Capretta

The likelihood that such a sizeable reduction in the uninsured can be achieved in 2014 is slim. To date, far more people have learned that they are losing their plans next year than have signed up for new coverage in the exchanges. Moreover, even though Medicaid enrollments are running above those in the exchange plans, they are still not nearly on pace to reach the levels promised at enactment.

Of course, in the original cost estimate, CBO assumed all 50 states would go along with the Medicaid expansion, while, in the wake of the Supreme Court’s decision, it now appears that only about half the states will do so. Further, CBO has altered some other assumptions that affect the coverage estimates.

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So perhaps Obamacare’s performance should be compared with the more recent CBO estimate, from which the administration has pulled its target for exchange enrollees. In those projections, CBO expects 9 million new enrollees in Medicaid in 2014, 7 million enrollees in plans offered on the exchanges, and a 2 million reduction in enrollees in individual insurance outside of the exchanges. So the net increase in insurance coverage for 2014 was estimated at 14 million people.

The administration’s recent announcement that the Healthcare.gov website will be functional by the end of November very likely means little to no enrollment over the coming month. From a dead start of very low enrollment as of December 1, the administration would need to have some 14 million new people come under coverage over a four-month period. Skepticism is clearly warranted.

Defenders of the law have cited the large numbers of Americans who’ve enrolled in Medicaid since the exchanges launched on October 1. But those numbers only look large relative to the anemic enrollment in the exchange plans. Of course, there will be many Americans — probably in the millions — who will eventually sign up for Medicaid under the expansion program. After all, it’s essentially free insurance.

But there has always been a sizeable “eligible but not enrolled” Medicaid population, even at existing income-eligibility levels. The effect of the individual mandate might bring more people into Medicaid over the coming year, but that’s an untested proposition. It could just as easily be the case that many millions of Medicaid-eligible families continue to wait to sign up for insurance only when they really need it.

In 2010, we were told that Obamacare would go a long way toward solving the problem of uninsured Americans, even in its first year of implementation. The latest estimates from CBO indicate that the law is supposed to produce a net increase in the insured population of 14 million people in 2014.

That’s a tall order, especially given the millions of Americans who are being pushed out of their existing individual-market plans. At this point, given the disastrous launch of Obamacare, it is not out of the question that the law would increase the uninsured rate rather than decrease it. Reaching the benchmark of 14 million newly insured would take a miraculous turnaround.

James C. Capretta is a senior fellow at the Ethics and Public Policy Center and a visiting fellow at the American Enterprise Institute.



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