Health care expert Bob Laszewski explains why the answer to this simple question should be the decisive factor in determining the relative success or failure of Obamacare:

Are enough people getting coverage who didn’t have it before to justify the sacrifices the people who were already covered––in the individual, small group, and large employer market––are making or will make? I will suggest the country will never really be able to judge how good or how bad Obamacare is until that question is answered…It’s easy to answer this question. We only need ask the carriers for two numbers:

  1. The number of people they insured (and were paid for) in both the individual and small group markets as of December 31, 2013––the day before Obamacare started covering people.
  2. The number of people that were insured (and paid for) in both the individual and small group markets on a specific date––March 31, 2014, for example.

I will suggest that asking for both the small group and individual market numbers is important as people have a tendency to move between the markets, particularly as employers drop coverage and their people go, or don’t go, into the exchanges. Then subtract one total from the other. We would have an excellent idea of just how many more people, net of any gains and losses, secured private insurance since Obamacare’s launch. Then people could make their judgments about how well Obamacare accomplished health insurance reform free from all of the spin.

Laszewski adds that independent of the previously uninsured issue, the administration’s enrollment figures are also inflated by counting unpaid “sign ups” — an issue we’ve covered ad nauseam.  The administration claims it doesn’t have access to payment delinquency stats, but that may not be true.  In any case, unless and until the White House releases complete and transparent data, the public will rely on outside estimates and studies to answer core questions.  So I’ll reiterate my question:  How many “new” Obamacare exchange enrollees were previously uninsured?  Laszewski takes a stab an answer, based on anecdotal reports he’s received from industry insiders:

My conversations with carriers suggest that about half of the enrollments come from the ranks of the previously insured. But that is just anecdotal information. I don’t have a hard number.

“Roughly half” is the most generous estimate I’ve seen.  Jonathan Cohn of the liberal New Republic points to data from a small handful of states where Obamacare is working relatively well as cause for hope among the law’s supporters.  But the national picture is murky — and based on three separate independent studies, the overall figures remain weak:

(1) RAND corporation – “A new study from the RAND corporation indicates that only one-third of exchange sign-ups were previously uninsured. The RAND study hasn’t yet been published, but its contents were made available to Noam Levey of the Los Angeles Times. RAND also estimates that 9 million individuals have purchased health plans directly from insurers, outside of the exchanges, but that “the vast majority of these people were previously insured.”

(2) Goldman Sachs – “Goldman Sachs is projecting that only 1 million Obamacare sign-ups will come from previously uninsured Americans. Indeed, it estimates that the number of total signups will be just 4 million — not 6 million, as the administration claims — because ‘HHS figures . . .count all persons who selected an ACA exchange plan regardless of whether or not they have actually completed the enrollment process by paying their premium.’ Goldman Sachs also anticipates that fully 75 percent of all the Obamacare sign-ups will be from people who already had insurance.”

(3) McKinsey – “Of the Obamacare sign-ups, only 27 percent had been previously uninsured in 2013. And of the 27 percent, nearly half had yet to pay a premium. (By contrast, among the 73 percent who had been previously insured, 86 percent had paid).”

American taxpayers have forked over $2 trillion to uproot an existing system with which most Americans were satisfied.  If only a fraction of the law’s “newly” enrolled previously lacked coverage, how many Americans will consider the broader expensive disruption to have been worth it?  Philip Klein notes how badly the White House has whiffed on Congressional Budget Office projections:

According to the Times, which cites a study from Rand Corp., “At least 6 million people have signed up for health coverage on the new marketplaces, about one-third of whom were previously uninsured.” That suggests that two million uninsured Americans gained coverage as a result of the law. Additionally, the article reports, “At least 4.5 million previously uninsured adults have signed up for state Medicaid programs.” So between Medicaid and the private exchanges, that makes 6.5 million previously uninsured Americans who have now gained coverage…But even as recently as February — when analysts knew how many states weren’t going along with the Medicaid expansion and were aware of the early technical glitches facing the rollout of Obamacare — the CBO still projected that the law would reduce the number of uninsured by 13million.

So they missed CBO’s anticipated target by 50 percent.  A new CBS News poll confirms what every other national survey has demonstrated. People dislike Obamacare — including younger Americans:

In an attempt to enroll healthier people into the health are exchanges, the Obama administration has been targeting young adults to sign up, but what do they think of the law? Well, they don’t like it so much. Despite young Americans’ overall support for President Obama (48 percent approve of the job the president is doing)…they are not enthusiastic about the ACA: 42 percent approve of it, but more (50 percent) disapprove — opinions were similar in January. Young Americans’ views on the health care law do not differ much from those who are older.

Millennials are uniquely screwed by the law’s generational wealth transfers.