The Conversation

Claim that 4 Million Enrolled in Medicaid Under Obamacare is Extremely Misleading

The Obama administration's Medicaid enrollment numbers mostly come from states that did not expand Medicaid under Obamacare.

My colleague John Hayward mentioned this on Friday but I wanted to highlight it again because it seems like something that would be getting a lot more attention if the media were not fixated on Chris Christie. Last month the Obama administration announced that 4 million people had enrolled in Medicaid under Obamacare between October 1st and Novermber 30th. 

Ezra Klein wrote of the Medicaid numbers, "It’s hard to say exactly how many of those Medicaid enrollments Obamacare is responsible for -- the government’s numbers don’t distinguish between people who signed up through Obamacare’s Medicaid expansion and those who entered the program through pre-existing channels."

That's not completely accurate since the reports do break down the numbers into states which expanded Medicaid and those which did not. For instance, looking at the November report, the total determined eligible for Medicaid in that month is 1.65 million. Of those, 911,000, 55 percent of the total, were in states that did not expand Medicaid under Obamacare. It's not clear why these individuals should count toward the total for Obamacare at all.

As Sean Trende points out, the CMS report says enrollment was actually down relative to a similar period (July-September 2013) before Obamcare took effect. For states that expanded Medicaid, enrollment was down 4.2 percent. For states that did not expand Medicaid enrollment was down 15.2 percent. At first glance it appears that Obamacare actually hurt Medicaid enrollment; however, it is likely that these preliminary numbers will be adjusted upward at a later date. 

But even if we assume enrollment was not negative the difference between states which expanded Medicaid and those which did not was only 11 percent. Sean Trende argues that this difference is the only amount which should rightfully be attributed to Obamacare since it's the amount that would not be there in the absence of the law. Using 10 percent as a rough guide, it works out to a few hundred thousand people.

Where did the rest of these enrollment numbers come from? Well, most of them were probably people who had already been determined eligible before Obamacare. If you check the footnotes in that CMS report you'll see that the Medicaid numbers in most states include "renewals." These people are new Obamacare enrollees in the same way that people who renew their drivers license are new drivers, i.e. not at all.

Finally, the CMS document we've been looking at is dated December 20, 2013. Nine days earlier HHS put out a report covering Medicaid enrollment for October and November. The December 11th report says the number of people determined eligible for Medicaid over the two months was 803,000. That's less than half the 1.65 million CMS reported for November alone just 9 days later. Clearly the numbers changed rather dramatically but it's not clear why exactly.

It appears that most of the Medicaid numbers the administration is claiming come from a) states which did not expand Medicaid under Obamacare or b) previously enrolled individuals who were being renewed and would have been renewed in any case. The actual number of people who can be said to have enrolled because of Obamacare is probably fairly small. No doubt the administration has an idea what that number is but they aren't saying.


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