Why the HHS report "only 13% currently insured" bit doesn't mean much

One of the more interesting parts of the March/April HHS report is that they finally released the data for the "Are you currently insured?" question on the HC.gov enrollment process.

Given all the fuss about "But how many were ALREADY INSURED???" from various outlets, this would seem to be a bit of a Holy Grail answer: At last, we know the answer, and it's pretty impressive: Only 13% responded that they had health insurance coverage at the time of their application, meaning a whopping 87% were newly insured! Wowzers!!

HOWEVER...there's a LOT of caveats here, just as there were with the infamous McKinsey study which claimed only 27% were previously uninsured back in February.

As the HHS report itself puts it:

The coverage question on the Marketplace application form is designed to capture whether an individual currently has health insurance, and not whether an individual may have been covered prior to the time of application. Applicants for financial assistance through the Marketplace are asked: “Are you enrolled in health coverage now from the following?”58 Responses to the coverage question do not capture, for example, whether an individual without coverage only very recently became uninsured or whether someone with insurance is applying to the Marketplace to prevent an impending loss of coverage.

As noted above, those who elect not to apply for financial assistance through the Marketplace do not encounter questions about insurance status. We are unable to report the prevalence of health insurance coverage at the time of application among the approximately 5 percent of enrollees who did not apply for financial assistance, as well as among those who enrolled in any off-Marketplace, Affordable Care Act-compliant plans.

58 The list of possible answers for the question relating to health insurance coverage at the time of application includes an option marked “Other.” At this time, we are unable to verify whether answers of “Other” are counted toward the number of individuals with health insurance coverage at the time of application in the CMS application data.

Health Insurance Coverage at the Time of Application among FFM Enrollees

Of the 5.45 million people who selected a Marketplace plan through the FFM during the period October 1, 2013–March 31, 2014 (including Special Enrollment Period (SEP) activity through April 19, 2014), 5.18 million (95 percent) applied for financial assistance and were required to answer a question about their health insurance coverage.59 Of these 5.18 million who applied for financial assistance and selected in a plan, 695,011 (13 percent) indicated that they had coverage at the time of application. 

In other words:

• The question only applies to the 36 states on the Federal exchange (5.45M people), meaning it doesn't tell us anything about the 32% of the total QHP enrollments from the state exchanges
• The question only applied to those who were requesting financial assistance (5.18M people), meaning it doesn't tell us anything about the other 5% on the Fed. exchange
• Most importantly, the wording of it is too vague to be terribly useful for this purpose...because, as they say: "Responses to the coverage question do not capture, for example, whether an individual without coverage only very recently became uninsured or whether someone with insurance is applying to the Marketplace to prevent an impending loss of coverage."
  In other words, what if they had insurance until a week or two ago, and the new policy they're applying for doesn't kick in for a few more weeks? Technically they're "not currently covered" but that's not really what people want to know.

So, in the end, saying "87% are newly insured" is just as flawed a conclusion from this study as saying "only 27% are newly insured" was from the McKinsey study. Don't get me wrong, I'd be thrilled if the magic number was 87% (and it's conceivable that it is), but there's no way to come to that conclusion based on the HHS data.

The truth is likely to be somewhere around 50/50 for the first enrollment period...which is what I've been saying all along.