Today is notionally the final day for ObamaCare sign-ups, so the usual suspects in the national media are engaging in some "how're we doin?!?' reporting cheerleading. At the risk of being struck by a pom-pom let me single out the LA Times - their story which has seized the post position at Memeorandum, deserves special mention for this dubious stat:
At least 4.5 million previously uninsured adults have signed up for state Medicaid programs, according to Rand’s unpublished survey data, which were shared with The Times. That tracks with estimates from Avalere Health, a consulting firm that is closely following the law’s implementation.
Sicne their headline included the factoid that "At least 9.5 million previously uninsured people have gotten health insurance since Obamacare started", that 4.5 million from Medicaid is a big deal. But how meaningful is that estimate?
A huge caveat that ought to be attached to that number (but hasn't been) comes from what has become known as the "woodwork effect" - with all the hue and cry about ObamaCare, people who were previously eligible for Medicaid have "come out of the woodwork" to sign up. An ardent ObamaCare booster might insist that they only way we could have ginned up all that publicitity was by crafting and cramming down a complex, unpopular bill; here on the third planet, we will argue that a much less complex PR campaign could have boosted Medicaid enrollment with a lot less controversy.
A new analysis by Avalere Health finds that the Affordable Care Act’s open enrollment season is boosting Medicaid signups even in the states that have refused the health law’s optional Medicaid expansion.
“Enrollment of new Medicaid beneficiaries continues in both expansion and non-expansion states,” said Jenna Stento, senior manager at Avalere Health, in a statement. “Medicaid applications have increased 27 percent on average from October to January compared to application rates before ACA. Application rates in expansion states increased 41 percent over the same period.”
Stento told ThinkProgress that enrollments even in non-expansion states grew by 13 percent from October through January, compared to previous months.
Avalere estimates that between 700,000 and 800,000 Americans in non-expansion states who were already eligible for existing Medicaid programs, but never actually signed up for them, enrolled between October through January. This is a phenomenon that health care experts refer to as the ACA’s “woodwork effect,” wherein eligible populations come “out of the woodwork” amid persistent national and local coverage of the health law’s signup period. Some of these people may simply not have known that they previously qualified for government health care benefits, or didn’t know how to sign up.
Expansion states saw much bigger enrollment hikes, with somewhere between 1.7 million and 2.7 million signing up for Medicaid for the first time, since some people in those places became newly eligible under expansion. All told, between 2.4 million and 3.5 million of the poorest Americans started receiving Medicaid coverage for the first time during the first four months of Obamacare’s enrollment season.
The population split between expansion and non-expansion states seems to be roughly equal (based on learning that the overall average increase of 27% comes from subgroups of 13% and 41%, as well as this map and this list.)
So if we assume 800k 'woodworkers' for the non-expansion state, how many similar people came out of the woodwork in the expansion states? One might argue that, lacking other information, it is plausible to assume that the proportion is the same. So, with total expansion of 3.5 million as of January (the high estimate), we would be estimating 1.6 million 'woodworkers' and 1.9 million people that are newly eligible under the revised and expanded law. The woodworkers represent 46% of the total.
But wait! One might argue that the states that expanded Medicaid have a long, proud history of generosity with other people's money and would have worked hard over the years to sign up as many eligible people as possible. In which case, substantially all of the 'woodworkers' will be found in the non-expansion states; this puts them at 23% of the total at the end of January.
Now, did the composition of Medicaid enrollees change substantially in February and March? Who knows? But lacking final reports, a fair range for the number of newly-insured 'woodworkers' would be 23% to 46% of the 4.5 million figure cited by the LA Times. That would lead to a 1 to 2 million reduction in the new Medicaid enrollment and consequently a 1 to 2 million reduction in the headlined 9.5 million figure.
Like the LA Times will note this.