Providing coverage to the 47 million uninsured Americans is a central goal of the nation's new health care law, but just weeks before the enrollment deadline the number of newly insured is still a mystery.

That's because many health exchanges signing up millions of Americans for health plans didn't clearly ask: Do you already have insurance?

On Thursday, officials with Covered California trumpeted the latest enrollment numbers from the Golden State's health exchange: 923,832 people in private health plans; another 2.1 million are either newly enrolled or have been determined eligible for the state's version of Medicaid, called Medi-Cal. Nationally, about 4.2 million people have signed up for private plans, and 6.5 million enrolled or qualified to enroll for Medicaid.

But there are limited hard numbers on how many of them were uninsured before this year, a puzzling omission that critics say undermines the impact of the new health care law.

"It's absolutely a central question,'' said Micah Weinberg, a health policy adviser at the business friendly Bay Area Council. "Is this drop in the uninsured caused by the expansion of health care coverage (through the new law) or the recovery of the economy? I think it's both."

One national survey released this month estimated 27 percent of those signing up in recent weeks previously had no insurance; others have been replacing their current plans.


Advertisement

While reducing the ranks of the uninsured was a major objective of the Affordable Care Act, it is not the only barometer for success: Providing better plans and reducing costs for individuals who aren't covered by an employer are also major goals.

But Covered California Exectuive Director Peter Lee on Thursday acknowledged the exchange could have done a better job tallying the newly insured.

The state's applications for health care included the question: "Do you have other health insurance or are you offered insurance through a job?''

To many, exchange officials agree, the question could have yielded conflicting answers.

Or as Lee said, the question "was not as artfully asked as it should have been,'' adding that the exchange expects to revise that question for next year's enrollment "to get better data.''

"It's an unfortunate oversight,'' said Gerald Kominski, a professor of health care policy at UCLA and director of the UCLA Center for Health Policy Research, of the opportunity to collect data that would have provided important answers.

"But it's not critical because we depend on other data sets for estimates of the uninsured,'' he said.

"I wish they had collected the information, but the fact that they have not is not an egregious oversight.''

UCLA conducts a California Health Interview Survey every two years. For the 2011-12 period, Kominski said, 5.4 million Californians reported being uninsured at the time of the survey, while close to 7 million reported being uninsured at some point during the past year. The 2013-14 survey is now in progress.

But another study of projections surrounding Obamacare's first-year enrollment in California, jointly created by UCLA and UC Berkeley health and labor policy experts, projected that during the first year of enrollments between 21 and 38 percent of individuals expected to sign up for a health insurance would be uninsured.

For the moment, at least, the best answers may come from recent independent surveys.

A Gallup poll this week that showed that the percentage of Americans without health insurance continues to fall, measuring 15.9 percent so far in 2014 compared with 17.1 percent in the fourth quarter of 2013.

The results were based on more than 28,000 interviews with Americans from Jan. 2 through Feb. 28 as part of the Gallup-Healthways Well-Being Index. The report said the drop could be a result of the Affordable Care Act.

But others, like the Bay Area Council's Weinberg, say it could also be due to the improving economy.

Like Gallup, a February survey by McKinsey & Company reported growth in the number of uninsured people buying health coverage in recent weeks.

Of those surveyed who had enrolled in health coverage in 2014, 27 percent reported they were previously uninsured. That's up from 11 percent in a McKinsey survey in January.

Contact Tracy Seipel at 408-920-5343. Follow her at Twitter.com/taseipel.