While the final figures will be somewhat different once the more complete end of year data is available, at this point it is reasonable to expect that for the three-year period of 2014 through 2016, the net increase in health insurance enrollment was 16.5 million individuals. Of that figure, 13.8 million were added to Medicaid and 2.7 million were the net increase in private-sector coverage enrollment.

In general, enrollment data indicate that the implementation of the ACA appears to have had three effects on health insurance coverage: (1) a substantial increase in individual-market enrollment; (2) an offsetting decline in fully insured employer-group plan enrollment; and (3) a significant increase in Medicaid enrollment in states that adopted the ACA Medicaid expansion.

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The Trump administration may stop enforcing the Obamacare requirement that most Americans carry health insurance even before Congress repeals the law, Kellyanne Conway, a top adviser to the new president, said in interviews broadcast on Sunday.

Such a move would take the teeth out of former President Barack Obama’s health-care law and could destabilize insurance markets, analysts say. It was not clear from Conway’s remarks whether President Donald Trump would try to use his executive authority to make the change, which would be much faster than writing new regulations or waiting on lawmakers.

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“What about the 20 million people who got coverage?”

Republicans are naturally concerned. Liberals have weaponized this number to stop repeal of the ACA. But should 20 million people keep a bad law on the books? To answer this question, Congress must ask two different questions.

First, is the number real? In March 2016, the Department of Health and Human Services (HHS) estimated that 20 million uninsured adults gained coverage under the ACA: 17.7 million non-elderly adults (ages 18 to 64) since October 2013, and 2.3 million young adults (ages 19-25) between 2010 and 2013.

The estimates are based on data from the National Health Interview Survey and the Gallup-Healthways Well-Being Index. The estimates are “adjusted to account for changes in general economic conditions (via employment status), geographic location, demographics and other secular trends.” Thus, the 20 million is an estimate, not a rock-solid fact.

. . .

While the average estimate shows nearly 21 million people have benefitted from Obamacare, it’s important to note that some people currently enrolled in Medicaid could have enrolled in Exchange coverage with nearly full subsidization had their state not expanded Medicaid, and would likely be eligible for whatever new subsidy structure might replace the current system. Regarding those in the Individual Market, not all of these individuals are receiving subsidies and would therefore not be financially impacted by the repeal. Making reasonable assumptions and accounting for those who lost insurance because of the ACA, and setting aside any assistance that would be provided by ACA replacement policies, the number of people who, on net, are potentially at risk of being negatively impacted is likely closer to 13-14 million.

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Beginning in January, the Republican-controlled Congress, working with the incoming Trump administration, will have the opportunity to roll back the Affordable Care Act and replace it with a plan that is less driven by federal control and regulation. The starting point for this effort ought to be that everyone in the United States should have health insurance, protecting them against major medical expenses. To do so, the GOP should:

  • Grandfather Coverage Provided by the ACA
  • Accept and Clarify Medicaid’s Role as the Safety Net Health Insurance Program
  • Impose Cost-Discipline and Generate Revenue with an Upper Limit on the Tax Preference for Employer-Paid Premiums
  • Build an Effective Auto-Enrollment Program to Achieve Higher Levels of Coverage

House Republicans, responding to criticism that repealing the Affordable Care Act would leave millions without health insurance, said on Thursday that their goal in replacing President Obama’s health law was to guarantee “universal access” to health care and coverage, not necessarily to ensure that everyone actually has insurance.

“Our goal here is to make sure that everybody can buy coverage or find coverage if they choose to,” a House leadership aide told journalists on the condition of anonymity at a health care briefing organized by Republican leaders.

. . .

The main objective of the Affordable Care Act (ACA) was to increase enrollment in health insurance among those who were previously uninsured. Official estimates from the Census Bureau have consistently overstated the number of people who are uninsured. A major factor in the overestimate is the undercount of people in Medicaid. Also, millions of Americans have been officially uninsured despite their eligibility for public insurance or employer coverage. With the passage of the ACA, fewer than 10 percent of the remaining uninsured do not have a realistic path to securing health insurance. The future of the ACA is now uncertain, but any future policy changes will likely need to provide a sure path to insurance coverage for all Americans as well.

. . .

The final Obamacare open enrollment of President Obama’s presidency starts Tuesday with enrollees facing fewer insurers and higher premiums for health coverage.

However, the impact will largely depend on where the enrollee lives, as some states are faring far worse than others in plan offerings and rates.

The administration wants to get 13.8 million people to sign up between Nov. 1 and Jan. 31, and it hopes about 11 million will pay for coverage throughout 2017. However, some experts doubt whether the administration can reach that goal because of higher plan costs.

. . .

Under pressure to stabilize wobbly insurance markets nationwide, the Obama administration is making a new push to sign up Americans for health coverage through the Affordable Care Act, aiming to increase enrollment by about 1 million in 2017. With insurers canceling health plans or raising premiums by double digits in many parts of the country, that represents only modest enrollment growth over 2016.

. . .

Less than half of the approximately 27 million uninsured people in the U.S. are eligible for federal financial assistance, an analysis released Tuesday by the Kaiser Family Foundation shows.

Roughly 11.7 million, or 43 percent of that population, are not taking advantage of some sort of federal assistance to get health insurance that they are eligible for, according to the analysis. That assistant may be in the form of a subsidy to purchase a policy on the Affordable Care Act exchange or a Medicaid plan a consumer is eligible for but not signed up for.

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