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Fact check: Are government estimates of health insurance coverage based on survey data?
January 20, 2017
By Amée LaTour
A Heritage Foundation video claimed that, contrary to the Obama administration’s estimates, the Affordable Care Act (ACA) has not insured 20 million people. "The administration’s estimates are based purely on survey data, not actual calculations on the change in coverage in different markets. Other reports that use enrollment data from Medicaid and private insurance companies found that just over 14 million people gained coverage between 2013 and 2015."[1]
Are administration estimates of ACA coverage gains based purely on survey data?
The Department of Health and Human Services (HHS) stated in a March 2016 report that its latest estimate of coverage provided under the ACA is based on data obtained from two surveys: the National Health Interview Survey (NHIS) and the Gallup-Healthways Well-Being Index (WBI). HHS adjusted the data to account for factors other than the ACA that may have influenced the change in uninsured rate, such as economic conditions, geography, demographics, and other secular (long-term) trends.[2]
Data sources
The National Health Interview Survey is conducted by the National Center for Health Statistics, a division within the Centers for Disease Control and Prevention. The main objective is to monitor the health of the population through the collection and analysis of data on a broad range of health topics.[3] The Well-Being Index, compiled by Gallup and Healthways, measures Americans' perceptions of their lives and their daily experiences.[4]
The Heritage video cited data from insurers and from the Centers for Medicare and Medicaid Services (CMS) on changes in coverage rates within the individual market, employer market, and Medicaid and CHIP programs. The data for individual and employer markets was obtained through Mark Farrah Associates, a business that collects data from the health insurance industry which it makes available to paid subscribers.[5][6]
Estimates
The Heritage Foundation video noted the administration’s use of survey data to claim that the Obama administration overestimated the number of individuals who gained coverage under the ACA by several million.[1]
The time period for the HHS estimate of 20 million is from 2010, the year in which the ACA was enacted, through February 2016, after the end of the third open enrollment period.[2] It wasn’t until 2014 that Medicaid was expanded, which accounted for the majority of new coverage. That was also the year that the government insurance exchanges opened, allowing individuals to purchase taxpayer-subsidized policies.[7]
The estimate cited by Heritage included children under 18 years of age and adults older than 64 who were covered by an insurer other than Medicare, while the HHS estimate only included adults 18 to 64 years old.[5][2]
Conclusion
A Heritage Foundation video claimed that the Obama administration based its estimate of the number of people who gained coverage through the ACA “purely on survey data,” and stated that other reports estimated that just over 14 million people had gained coverage through the ACA, not 20 million.
The Department of Health and Human Services based its estimate that 20 million adults aged 18 to 64 gained insurance through the ACA on survey data from the National Health Interview Survey and the Gallup-Healthways Well-Being Index. However, researchers also adjusted the data for other factors that could influence changes in insured rates.
See also
- Fact check/Are there places where a single insurer is offering coverage through ACA exchanges?
- Obamacare overview
- Affordable Care Act under the Trump administration, 2017
Sources and Notes
- ↑ 1.0 1.1 Twitter, “Heritage Foundation,” December 14, 2016
- ↑ 2.0 2.1 2.2 Department of Health and Human Services, “Health Insurance Coverage and the Affordable Care Act, 2010-2016,” March 3, 2016
- ↑ Centers for Disease Control and Prevention, “About the National Health Interview Survey,” updated September 12, 2016
- ↑ Gallup, “How Does the Gallup-Healthways Well-Being Index Work?” accessed January 14, 2017
- ↑ 5.0 5.1 Heritage Foundation, "2015 Health Insurance Enrollment: Net Increase of 4.8 Million, Trends Slowing,” October 31, 2016
- ↑ Mark Farrah Associates, “About Mark Farrah Associates (MFA),” accessed January 14, 2017
- ↑ U.S. Department of Health and Human Services, “Key Features of the Affordable Care Act By Year,” accessed January 18, 2017
Launched in October 2015 and active through October 2018, Fact Check by Ballotpedia examined claims made by elected officials, political appointees, and political candidates at the federal, state, and local levels. We evaluated claims made by politicians of all backgrounds and affiliations, subjecting them to the same objective and neutral examination process. As of 2025, Ballotpedia staff periodically review these articles to revaluate and reaffirm our conclusions. Please email us with questions, comments, or concerns about these articles. To learn more about fact-checking, click here.
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