31 Million and Growing: The ACA’s Beneficiaries in Context

Later this week, the Supreme Court takes up a new case regarding the Affordable Care Act, King v. Burwell. At risk are subsides that make insurance affordable for many of the Americans who have signed up via the healthcare exchanges. We thought that given how far the law has come, that now would be a good moment to put its progress in perspective. A court decision that rules against the government would have enormous ramifications.

While the Department of Health and Human Services (HHS) has used 11.4 million as the number of beneficiaries of the ACA, we find that the number of Americans benefitting from the ACA is far higher. Steve Ratter’s recent piece in the New York Times cites data from ACAsignups.org, and illustrates that the true number of beneficiaries is over 31 million Americans. And the number may be even higher as neither analysis can fully account for the number of young people who gained insurance coverage by staying on their parents’ healthcare until 26.

If we go with the 31 million number as an estimate, then we have an almost intangible amount of Americans benefiting from the law. How do we put that number in a better context?

Within the first 18 months, the 31 million people benefitting from the ACA are now:

  • About 15.1% of the entire American population that falls between the ages of 18 and 65.
  • The size of 1/5th of the entire workforce in the United States.
  • More than twice as large as the number of members of labor unions in the United States.
  • Eight times larger than the entire federal government (including military and civilian personnel).
  • 60% of the total Medicare population. There are currently about 50 million people enrolled in Medicare.

Beneficiaries of the ACA are a larger group than labor, the number of employees of the federal government, and other major political groups. This number is likely to grow, as the law has only been fully operating for a year-and-a half. Thus, their needs should not be ignored by Congress or the Supreme Court—particularly when a court case later this week threatens the health insurance benefits of many ACA enrollees. According to a new poll by Hart Research, the American public disapproves of the Supreme Court negatively impacting subsidies by 63% to 29%. Republicans are not far off disapproving of a removal of subsidies by a margin of 56% to 31%.

In the past two years, the number of people uninsured has fallen by about 11 million people. The percentage of the country that is uninsured, according to Gallup, has fallen from about 18% to 12%. These changes have enormous impact, in terms of how Americans will go about taking new risks and what type of impact this freedom will have on their general view towards the U.S. economy. For what it’s worth, the general view on the ACA has reached the point where for the first time more people want to keep or expand the bill as opposed to replace it, according to a poll by Yougov.

Essentially, the ACA has reached the point of no return, and has woven itself into the American healthcare system. It is working as intended, by lowering the number of uninsured, bending the cost curve, and reducing the deficit. What this new data and polls number suggest is the proponents of the law have been underselling the positive and monumental changes that are brought forth when Americans finally feel secure in that an injury or illness will not bankrupt their family. And that the political landscape around the ACA has shifted in the short time since full implementation began.