Megan McArdle asks: where are all the uninsured? #obamacare

It’s a serious question.

…Somewhere between 65 percent to 90 percent of the 2.2 million folks who bought insurance on the exchanges through late December seem to be people who already had insurance. Some came to the exchanges when their policies got canceled; others came, voluntarily or not, from the employer market. But various sources suggest that the number of previously uninsured people who have so far bought policies on the exchanges is somewhere south of 750,000.

To put that number in perspective, the Congressional Budget Office projected that the exchanges would sign up 7 million people in the first year, roughly 2 million of them transitioning from other insurance plans and 5 million of them previously uninsured. If the Journal’s numbers are right, then by the end of December, the exchanges had signed up at least 1.45 million previously insured folks out of the 2 million who were projected to enroll by the end of May — roughly 75 percent of the projected total. But at most, they’ve signed up 15 percent of the uninsured that they were expecting to enroll. You’d expect the early numbers to be somewhat weighted toward the previously insured, who probably want to maintain continuous coverage. Still, this is a fairly wild skew, and it leaves us with a burning question: Where are the uninsured? Did hardly any of them want coverage beginning Jan. 1?

My knee-jerk reaction to that would be that the 750K represents at least a fair chunk of uninsured people who actually wanted health insurance… and who were able to both afford it, and get the blipping site to work.  In this, I am slightly in disagreement with Megan McArdle: she’s holding out hope that a lot of the uninsured are simply waiting until the end of March, presumably under the assumption that surely by then the site will function properly. But she considers what I’m assuming to be a bit of a nightmare scenario: “There may be something seriously wrong with our understanding of who the uninsured are, and what they are willing and able to buy in the way of insurance.”

I freely admit that Megan is more of a wonk and a policy analyst than I am: I am, in fact, a partisan hack, a unapologetic propagandist, and a cheerful Republican Party man. But I have never trusted the arguments that blithely waved off observed reality because the theories were so much more engrossing. The brutal truth of it is, if the pre-Obamacare healthcare situation was as bad in this country as the Democrats suggested that it was then it would not have taken Democratic super-majorities in Congress to pass it.   It would not surprise me in the slightest to hear that our fundamental assumptions about the percentage of insurance coverage in America were incorrect.  After all, as the man said: there are lies, damned lies, and statistics. I see no reason why this cannot be as true in health care policy as it is anywhere else.

Moe Lane