"so you can find out what is in it"

Health Affairs recently published an article co-authored by 6 actuaries and economists within the Medicare Office of the Actuary in Baltimore.

It’s a good article, focused on spending projections. Exhibit 5 in the article summarizes the Medicare Actuary’s estimates of enrollments in various insurance programs – both public and private - under current law and under the new (reform) law, for the years 2009 thru 2019.

In particular the enrollment projections for the years 2013 and 2014 are interesting because 2014 is the first year for “full” implementation of health care reform, including the individual mandates and insurance exchanges. Comparing the enrollments projected for 2013 under current law with 2014 under reform law illustrates just how remarkably the insurance landscape is expected to change in 2014.

By far the largest changes are projected for two areas.

First, the uninsured, and this should not be a surprise. The uninsured are estimated to reduce from 50.9 million projected for 2013 under current law, to 25.5 million in 2014 under the reform legislation, a reduction to the uninsured of 25.4 million. That’s a 50% reduction in the number of uninsured. Of course a 100% reduction is unrealistic but couldn’t one have hoped for a reduction larger than 50% in exchange for committing those trillions of our grandchildren’s dollars? Oh, never mind.

The second expected large change is in the number of Medicaid/CHIP insured. This number is expected to grow from 63.4 million projected for 2013 under current law to 85.2 million in 2014 under reform legislation – an increase of 21.8 million people.

Fewer uninsured by 25.4 million. More Medicaid/CHIP by 21.8 million. In other words, health care reform is expected to reduce the uninsured by half, and just about all those people will gain insurance through Medicaid/CHIP. That may be a rather more surprising outcome to many observers.

But actually, growing Medicaid/CHIP is about the only way a meaningful reduction to the number of uninsured could be achieved.