How successful will the ACA be?

Longtime readers of the blog will know that I tend to like to cite McKinsey data and analyses, especially when the methodology is well described.  Today, a piece appeared in KHN where Amita Parashar talked with Dr. Robert Kocher, director of the firm’s Center for U.S. Health System Reform.  Specifically, she asked him how many people will still be uninsured in 2016 under the ACA, with the mandate in place:

A. We built a simulation that allows us to model each county in the country. The model looks at businesses and individuals, coverage flows and changes over time. The model factors in health conditions, incomes, age and can allow one to make forecasts. … It is difficult to predict how big the residually uninsured market will be since it depends on many factors — how effective the individual mandate proves to be, how well auto-enrollment works [a provision of the law that will require large employers to enroll employees in a health plan, unless workers choose to opt-out], and how effectively exchanges and Medicaid programs work to enroll people. Depending on what you believe about these factors leads you to a large range for how many people will be residually uninsured. In some scenarios, that pool may be as large as 30 to 40 million people.

Obviously, I (and you) will want more details on that model.  But that’s a surprisingly large number of people, and that’s with the mandate.  No one thinks that if there were no mandate, that the number of uninsured would be less.

This is significantly more uninsured than predicted by CBO models.  I’d like to know why that’s so.  And if it’s right, once again, the ACA is going to have failed in the expectations game.

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