How Numbers Are Manipulated in the Obamacare Debate

Ah … numbers are enough to drive one crazy unless you’re a math fanatic. I’m definitely NOT!

So Why Did I Undertake Research on Obamacare Numbers?

I was inspired by a tweet from Gerard Gianoli, M.D., one of the doctors I follow on Twitter, to look into the number of people who had their health insurance plans canceled as the Obamacare exchanges opened in the fall of 2013, and people started to sign up (or in many cases, TRIED to sign up) for one of the Obamacare-compliant plans with all the bells and whistles. Then there have been cancellations for other reasons as well.

I had originally responded to an editorial in The Hill that Dr. Gianoli had posted, “Debunking the 20-million Obamacare Myth,” written by opinion contributors Justin Haskins and Michael Hamilton. The article showed how all the numbers that were used to make Obamacare look like a big success over the last three years were very fungible. And indeed they are.

My Foray Into Numbers – Ouch!

I’m not going to put you to sleep with a whole array of numbers here because frankly they make my head spin, but the basic premise of this editorial was that the oft-cited number of 20 million people in the United States who have gained health insurance coverage via the Affordable Care Act since it became effective in 2014 is closer to 16.5 million than 20 million. However, that estimate is not limited to those who gained commercial insurance through the ACA; it includes approximately 2,044,809 of those new “enrollees” being signed up for Medicaid and the Children’s Heath Insurance Program (CHIP) primarily because of the Medicaid expansion in many states, which offered “coverage” to able-bodied low-income people and was almost completely subsidized by government.

Dr. Gianoli brought up the point about the many people who lost insurance because of the ACA. I suppose that number could include those with individual insurance policies prior to 2014 who had them canceled because they did not meet the coverage mandates required by the ACA. It could also include those who lost insurance for a plethora of other reasons such as employers cutting employee hours so they didn’t have to provide benefits, etc. So I set out to do a little bit of internet research. Here is what I found, and the results of my research were dizzying.

According to the website, the Associated Press had cited a number of people whose insurance policies had been cancelled because of non-compliance with ACA mandates to be 4.7 million. However, according to, an article published on the journal Health Affairs’ website estimated that number to be more like 2.6 million. Apparently that estimate was based on the work of two researchers with the Urban Institute, which has been a known cheering section for Obamacare.

In an online editorial in Forbes entitled “How Many People Has Obamacare Really Insured” by Scott Gottlieb, he cites two different studies of the actual numbers that Obamacare can be credited with insuring – one by Goldman Sachs and one by the Rand Corporation.

According to Gottlieb, the Goldman Sachs study estimated that total insurance coverage as the result of the ACA increased by between 13 and 14 million in 2014 with a possible 4 million people being added to that number in the first five months of 2015, for a grand total of 17 to 18 million people “newly” covered in that period.

The Rand Corporation estimated that a total of 22.8 million people gained coverage under the ACA, and yet it also calculated that 5.9 million people lost coverage as the result of the law, which brings the estimate of actual covered lives as a result of the ACA to 16.9 million, which is really not far, in either direction, from the estimates of the Goldman Sachs study or the estimates in the The Hill editorial.

It is interesting to note that the Forbes article did not state the reasons an estimated 5.9 million people lost health insurance as the result of Obamacare. That may include those who lost it because their plans prior to 2014 did not meet the Obamacare compliance standards as well as those who lost coverage because of insurance carriers withdrawing from the Obamacare exchanges when they found they were experiencing too much in the way of losses. Who knows? That estimated number could even include those who decided the Obamacare plans were worthless and concluded that they would be better off not having insurance while Obamacare was still in effect, even though that clearly has some risk attached.

All in all, whether the number of people who lost their insurance as a result of Obamacare was 2.6 million or 5.9 million, or somewhere in between, the REAL number of people being covered by Obamacare has never actually reached the 20 million additional people the ACA proponents claim. No matter what, you can tell how easily manipulated as well as only partially reliable numbers can be.

Yet even today, I have come across “figures” being touted that 30 to 32 million people will “lose insurance” if the Unaffordable¬† Care Act is repealed without a replacement. All I’ve heard from Congress and Trump is replacement, replacement, replacement … so where are those people getting their information? From the fake news?

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