Some AHCJ members have noted that when they go online to find out the estimates for coverage under the Affordable Care Act, they find a whole bunch of different numbers.
That’s because
- no one really knows
- some changes to the law – most significantly the Supreme Court making Medicaid expansion optional for states – have changed the estimates since the law was passed in 2010
- no one really knows.
However the Congressional Budget Office remains the most official authoritative source. CBO updated its numbers most recently in May – and then made another tweak (a net half-million coverage decrease for 2014) after the employer mandate was postponed for a year.
Here’s the May update.
Here’s the document on the employer-mandate impact.
The bottom line is that the CBO now estimates an increase of 16 million people getting covered in 2014 (7 million in the exchanges, 9 million in Medicaid/CHIP).
By 2023 – a decade from now – the estimate is 37 million in Medicaid and the exchanges.
But some other sources of coverage will decrease, the CBO said. For instance, some people who now get covered on the job will end up in the exchanges (how many is another guessing game…though most experts don’t expect big businesses to drop coverage, some smaller and midsize ones might – the SHOP exchanges are actually designed to cover small business workers). So the net gain in coverage in 2023 is about 25 million.
NOTE: I had to update this post because I made a mistake the first time around – the first time I’ve had to fix something since I started doing these posts a few years ago. So how did I – who is careful and experienced – get this wrong? By not listening to my own instincts. I was looking at the CBO tables, my eyes scanning for the words MEDICAID, CHILDREN”S HEALTH and EXCHANGES. I found them, added up the numbers and dashed off a quick response to AHCJ’s electronic discussion list, and I later used that to write the post.* I didn’t look closely enough at other information on that page (and tables can be hard to read).
But as I was typing it, I was thinking to myself, wow 37 million is more than I thought. I then told myself it was probably because earlier estimates I had seen were a slightly different time frame, extending not to 2020 or 2021 but all the way to 2023. CBO was probably seeing an uptick in the later years as exchanges matured and more states took Medicaid. That was a good theory – but it was wrong. Lesson learned.
I wasn’t just being facetious about “no one really knows.” We don’t.
The CBO has very smart people but they are making economic assumptions and modeling behavior about enrollment in the Affordable Care Act based on historic enrollment patterns in health programs that are very different kinds of coverage AND taking place in a totally different political/messaging environment. And they are making guesses about how many states will expand Medicaid and when. That’s in flux and we can’t really know what, say, Florida will do three or four years from now. But if you want to use the most authoritative official estimates, the CBO is still your best bet.
