So here is something that has perplexed me for a long time, watching the (largely successful) rollout of health reform (the Affordable Care Act).

For months now, many very bright people (pundits, reporters, Legislators) have been fixated on one part of the Affordable Care Act (ACA)'s rollout and using it as a ruler to measure the law's success: the number of people enrolled in the MARKETPLACES -- whether the law would reach the target of roughly 8 million people enrolled in the "Marketplaces" (or Health Insurance Exchanges, as they were originally called).  Thus, when the Marketplaces hit 8 million enrollees, roughly, this was hailed as "Obamacare" reaching its target.

What is rather bizarre about this is that the goal for the ACA was always about reducing the uninsured (not simply enrolling people in the Marketplace) and the law was largely going to do this in two main ways: (1) through the Marketplaces, and (2) through expansions of Medicaid.  (this even ignores other ways the law would expand coverage and reduce the uninsured, but I will ignore that for now, since the vast bulk of the newly insured were always assumed to come through these two avenues).

As proof of this, the source of the widely reported estimate of 8 million people to be enrolled in the Marketplaces (which somehow became a goal or target) was the Congressional Budget Office's estimates produced after the law passed in 2010.  But note that in that estimate, the CBO also estimated that 10 million people would be covered by Medicaid (see page 21 of the final estimates linked above).  So the estimate was the uninsured would drop by 19 million (out of a projected 50 million at the time), or by about 38% of the total uninsured.  BUT THE KEY POINT HERE IS THAT MORE THAN HALF OF THE DROP IN THE UNINSURED WAS PROJECTED TO COME FROM MEDICAID EXPANSIONS (10/19=53%), with a small increase expected to come from expansion in employer coverage (and the employer mandate has been delayed in 2014).   

The estimate of the number to be covered by the Medicaid expansion was subsequently lowered due to the Supreme Court decision, which made the Medicaid expansion voluntary to each state.  So, after the SCOTUS decision CBO projected that 9 million would be covered by the Marketplaces and 7 million by Medicaid, with a net effect on the uninsured of -14 million. So at that point the CBO projected that roughly half of the net reduction in the uninsured would come from Medicaid expansions in 2014 (7/14 million).  

It is worth noting that at this point the CBO's estimates are almost perfectly on target: the Marketplaces enrolled about 8 million and Medicaid enrollment has increased about 6 million to date (through April, but individuals can still enroll throughout the year). 

But again my larger point is:  why have so many learned people, educated pundits and reporters, those on the Hill who actually do understand many aspects of the ACA still don't seem to understand that it always was the case that roughly half of the reduction in the uninsured was going to come through Medicaid expansions?