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The Dose - JK Wall

Welcome to The Dose, which tackles the finances behind local health care and life sciences and points to the most interesting national analysis. Your host is J.K. Wall.

Health Care & Life Sciences / Life Science & Biotech

Data show 1 in 5 uninsured Hoosiers gained health coverage this year

November 13, 2014

Turning non-customers into customers is one of the surest routes to business success.

And on that basis, it’s hard not to conclude that Obamacare is a success.

A recent county-by-county analysis by a D.C.-based not-for-profit called Enroll America shows that the number of uninsured Hoosiers has fallen by 21.7 percent this year, compared with last year.

That means, by my calculations, roughly 130,000 new customers for health insurers. And if history is any guide, it also means 130,000 folks that are now twice as likely to visit a doctor or hospital.

Which is why, as I wrote a couple weeks ago, Obamacare is perceived as good business all around right now among investors.

Of course, it also means there are still about 470,000 Hoosiers without health insurance. And that is also why five additional insurers are set to start selling on the Obamacare exchange in Indiana on Saturday.

“We think just the tip of the iceberg has been scratched with the uninsured. That’s why you have all these companies gearing up,” said Tony Nefouse, an individual health insurance broker in Indianapolis.

The enrollment gains have come at a price--individual insurance premiums estimated to be 31 percent higher than they would have been without Obamacare.

 But if the Enroll America estimates are accurate, it’s really stunning because Indiana has seen that kind of reduction in the uninsured even without an expansion of eligibility for Medicaid. Gov. Mike Pence’s staff continues to talk with the Obama administration about using Obamacare’s Medicaid expansion money to instead grow the Healthy Indiana Plan to roughly 300,000 more Hoosiers.

But so far, this increase in coverage has come via other features of Obamacare (and one factor, which I’ll detail later, that has nothing to do with the law.)

First let me tell you how I landed on that 130,000 figure.

Enroll America constructed a model to predict rates on uninsurance in each county, and then calculated the change—in percentage points—from last year to this year.

You can see those changes on a U.S. map here.

Or you can download Enroll America’s spreadsheet here.

I took those numbers and multiplied them by the 2013 Census Bureau estimates for each of Indiana’s counties. That produced an estimate of 1.14 million uninsured Hoosiers last year, falling to 889,000 this year.

The difference between those numbers is 21.7 percent.

Now, I think the Enroll America's estimates are too high. They imply that the uninsured rate in Indiana last year was 17.3 percent. But the Census Bureau estimated it at 14 percent.

But let’s assume Enroll America got the year-over-year change correct, even though its beginning estimate was too high.

The Census Bureau estimates there were 903,000 Hoosiers without insurance last year. If that number came down by 21.7 percent, it would mean 196,000 fewer people are now uninsured.

The Census Bureau's survey is supposed to measure the number of folks who were uninsured for the entire calendar year. But previous research has shown that respondents instead seem to say whether they were uninsured at the time they were surveyed, which is a higher number.

The number of folks that were uninsured for the entire year is about 25 percent ot 50 percent lower than the Census Bureau number, according to this analysis by the Congressional Budget Office.

So I reduced the number of uninsured in Indiana by one-third, to just under 600,000. To reduce that number by 21.7 percent, you have to take away nearly 130,000 people.

Does that number seem plausible, based on other things we know? I think it does.

Medicaid enrollment in Indiana has gone up by 50,000 in the past 12 months. Most folks attribute that rise to Obamacare’s tax for going without coverage, which kicked in this year at $95 per adult. It will rise to $395 per adult next year.

We also know that about 120,000 Hoosiers purchased health insurance on the Obamacare exchange last year.

Now some of those folks were formerly insured by their employers, which then ended their group health plans. But a recent Yale study suggests the total individual insurance market in Indiana grew by 47,000 people--going from 178,000 before Obamacare to 225,000 after it.

Also, employers are covering more people—for two reasons.

First, the participation rates in employer health plans has been going up, according to benefits brokers—as people who previously skipped coverage are now signing up to avoid Obamacare’s tax. We don't know the extent of this "migration" into employer plans. But if it’s equal to even 0.3 percent of the total number of Hoosiers with employer-sponsored insurance, it would extend coverage to 12,000 additional Hoosiers.

At the same time, employment in Indiana has been ticking back up. According to the Bureau of Labor Statistics, there are now 60,000 more Hoosiers employed than at this time a year ago.

If even only one in three of those jobs has come with health insurance that the worker has accepted, it would add another 20,000 to our total.

So we have 50,000 more in Medicaid, plus 47000 more in individual insruance products, plus 32,000 more in employer insurance plans.

That gets us to 129,000 newly insured Hoosiers.

It’s an impressive total, given the circumstances. Now we’ll have to see if that number grows much going forward or not.

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