By Robert Laszewski

First Posted at Health Care Policy and Marketplace Review on 3/11/2014

Bob Laszewski, Host of Health Care Policy and Marketplace Review
Bob Laszewski, Host of Health Care Policy and Marketplace Review

Reading the many press reports about the new Gallup poll estimating the number of the uninsured I couldn’t help be surprised by their surprise.

Under the headline, “Obamacare Working?” CBS reported that Gallup found the uninsured rate had fallen to 15.9% in a survey taken during January and February. That was down from 17.1% at the end of 2013––a reduction of 2.5 million adult Americans.

Other news reports have pegged the reduction in the uninsured to be worth as many as 4 million people.

The Los Angeles Times headline said, “Obamacare Meeting Goal of Reducing Number of Uninsured, Data Indicate.”

Well, dah!

The Gallup survey is fully consistent with the reports that Obamacare’s enrollment is coming in at a tepid rate at best and there are serious questions about the number of uninsured that are buying Obamacare.

So the number of those uninsured dropped by 2.5 million to 4 million?

Avalere Health is estimating that the number of new Medicaid enrollments through January alone is in the range of 2.4 million to 3.5 million.

On this blog last week, I noted the low take-up rate for people eligible for a subsidy, previously insured and uninsured, at only about 15%. Within that low 15% take-up rate there are likely a million uninsured people who bought coverage and would total far less than 10% of the number of those who were uninsured at the end of 2013.

When Obamacare started there were at least 40 million people uninsured and eligible. That number has hardly been dented.

Celebrating a drop in the rate of the uninsured by about a percentage point doesn’t make a lot of sense in the context of the surprisingly low take-up rate in both Medicaid and in the insurance exchanges so far. In fact, the Gallup poll confirms, like the McKinsey survey last week, just how little an impact Obamacare is having so far on getting people covered.

Context, context, context.

Robert Laszewski
Robert Laszewski is president of Health Policy and Strategy Associates, Inc. (HPSA), a policy and marketplace consulting firm specializing in assisting its clients through the significant health policy and market change afoot. Before forming HPSA in 1992, Mr. Laszewski was chief operating officer of a health and group benefits insurer. Mr. Laszewski also publishes Health Policy and Marketplace Review, a blog focused on health care policy and marketplace activities.


  1. Context indeed Robert.

    2.5M – 4M newly insured americans that would still be uninsured without the ACA.

    I assure you the new insurance has made a radical difference in their lives if they should happen to suffer a serious injury or illness this year. Bankruptcy for medical expenses has been taken off the table for their families. The payor of last resort – Medicaid – is now off the hook and our tax dollars will not be used to pay their medical expenses.

    You get to decide when you are “impressed” with the results. IMHO this is a fabulous start and a sea change for the uninsured in our country.

    Dike Drummond MD

  2. Dike Drummond’s comments go to the heart of the matter. As one who’s been working to see improvements in access and quality for more than twenty-five years, what we now have is a BOLD LEAP FORWARD. It’s the most we could expect in our capitalistic biz model. Hurray for what people will at some point consider the best action on their behalf despite all the efforts to sink it.

    Marty Diamond


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