“500,000 people have signed up for #Obamacare.”
— U.S. Rep. Debbie Wasserman Schultz, D-Fla., in a Nov. 13 post on Twitter
A lot of numbers were thrown at us when the White House announced on Nov. 13 how many individuals had signed up for health care coverage through online marketplaces. The general consensus, including from many Democrats, is the early returns were underwhelming.
Still, there was a lot of confusion. How many successfully navigated through the error-laden federal marketplace’s website? Who actually bought coverage? Where does Medicaid fit into all of this?
U.S. Rep. Debbie Wasserman Schultz, D-Fla., tweeted a simple breakdown.
“This week we found out 500,000 people have signed up for #Obamacare,” the chairwoman of the Democratic National Committee said. “It’s good news, but we have more work to do.”
But is that an accurate overview, or did she oversimplify it?
To the numbers
The U.S. Department of Health and Human Services has the statistics of who signed up in the first month:
From Oct. 1 to Nov. 2, 1,509,883 people applied for coverage through a federal or state marketplace.
Of those individuals, 106,185 approved applicants actually picked an insurance plan — 79,391 through a state marketplace and 26,794 through the federal marketplace.
About a quarter of the people who applied, or 396,261, were told they were eligible for Medicaid or the Children’s Health Insurance Program.
Wasserman Schultz’s office said her tweet came by adding those who picked a private insurance plan to those deemed eligible for Medicaid. And it’s true. That total equals 502,466.
But have those people “signed up for Obamacare”?
President Barack Obama didn’t put it so bluntly. Instead, at a Wall Street Journal CEO Council meeting Nov. 19, he said “About half a million Americans are now poised to gain health care coverage beginning Jan. 1.” (Wasserman Schultz’s camp said they were simplifying matters to meet Twitter’s 140-character limit.)
We should note here that Obamacare is a complex law, not a single government program in which people enlist.
The Medicaid element in particular adds a perplexing twist. Medicaid is an existing state-federal health insurance program largely for the poor. The health care law allows states to expand Medicaid eligibility, and some are doing that.
According to HHS, about 400,000 individuals were “determined or assessed eligible for Medicaid or CHIP,” but are they actually signed up? Does the applicant have to take additional steps to officially enroll, just as he or she must pick a plan after the application is processed?
HHS said they shouldn’t have to. Instead, “the state Medicaid or CHIP agency takes additional steps to finalize an eligibility determination,” according to an HHS report.
In states such as Kentucky, which runs its own marketplace, it’s pretty seamless.
“We have a streamlined application process,” said Jill Midkiff, a spokeswoman for the Kentucky Cabinet of Health and Family Services. “Somebody comes in and gives the information, and if they’re determined eligible for Medicaid, then they’re directed to Medicaid.”
From there, the applicant picks a Medicaid provider, and if he or she doesn’t, one is assigned.
For states operating under the federal marketplace, the process involves a bit more red tape.
In some states, Medicaid eligibility is determined by the federal marketplaces, and if eligibility is met, the individual should be set. In others, the state makes the final determination of eligibility.
Florida, for example, opted out of the Medicaid expansion under Obamacare and chose not to operate its own marketplace. Some people applying through healthcare.gov are eligible for the state’s existing program. For those people, a spokeswoman for the Florida Department of Children and Families said determining final eligibility will be “quick but not automatic.”
But there’s a delay in that process. The federal marketplaces do not yet have the ability to transfer Medicaid eligibility data to the states. And it’s unclear when they will. With 36 states relying on the federal government to run the insurance marketplace, that could push back Medicaid enrollment for thousands beyond Jan. 1 if it is not fixed in the coming weeks.
As another example, Arizona expanded Medicaid but also allowed the federal government to run its exchange. There, officials are advising people who were told by the federal marketplace that they may be eligible for Medicaid to just apply through the state’s online Medicaid portal.
“Once all of these systems are running as they should, there will be no wrong door,” said Monica Coury with the Arizona Health Care Cost Containment Systems. “The account transfer of Medicaid-eligible from the marketplace to the state will be seamless. But for now, it’s not working as it should.”
A final note: It’s not clear how many individuals told they were eligible for Medicaid would have qualified even before the expansion of the program under Obamacare. So it’s possible a large chunk of new Medicaid enrollees would have qualified for the joint federal-state program before passage of the Affordable Care Act.
Our ruling
Wasserman Schultz said “500,000 people have signed up for #Obamacare.” The numbers add up if you count different parts of the law that work together to expand coverage, but it’s a little simplistic. The fate of many of the Medicaid enrollees remains uncertain due to the problems with the federal marketplace. It’s unclear whether those individuals will receive their benefits on time, and some are being asked to take additional steps to sign up. Her statement is partially accurate but leaves out important details. We rate her statement Half True.
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