Does RAND’s coverage-uptick research add up?

The number of American adults with health insurance coverage from September 2013 to mid-March 2014 increased by 9.3 million – shaving the uninsured rolls to 15.8% from 20.5%, according to a new RAND survey. At least one skeptic, however, says the numbers are skewed and defy conventional wisdom.

RAND attributed the significant uptick in coverage mostly to enrollment in employer coverage, with HIX plans introduced under the Affordable Care Act and Medicaid rounding out the group of newly insured individuals.

But critics of the ACA have questioned the accuracy of these findings. “The idea that employer-sponsored insurance increased by 8.2 million is simply absurd,” said Greg Scandlen, founder of the nonprofit Consumers for Health Care Choices, in a recent blog. “If anything, the cutbacks in hours and growth of part timers would suggest the exact opposite.”

He went on to cite a U.S. Bureau of Labor Statistics estimate that only about 1 million jobs were created during that time period, described as “the peak of the 2013 surge in non-insurance,” and wondered where the remaining 7.2 million came from.

Katherine Grace Carman, a RAND Corporation economist, considers his hypothesis “reasonable” on the surface, but hastens to add that “it’s just not what our data shows.” Among the possible explanations for any perceived discrepancies that she cites: More people who previously declined coverage now accepting coverage, regardless of whether jobs are being created and including those who signed up for a spouse’s plan, as well as improved economic conditions that expanded the number of jobs offering health benefits.

“Over the coming months and years, further change can be expected as people become more familiar with the law, the individual mandate penalties increase to their highest levels, the employer mandate kicks in, and other changes occur,” Carman explained in a recent blog about the survey findings with RAND senior economist Christine Eibner.

“But early evidence from our survey indicates that the ACA has already led to a substantial increase in insurance coverage,” they wrote. “Consistent with the design of the ACA, this gain in insurance has come not only from new enrollment in the marketplaces, but also from new enrollment in employer coverage and Medicaid.”

The researchers noted shifts from one type of health insurance to another resulting from changes in one’s job or marital status, though they couldn’t with any certainty trace any such activity to the ACA and could only “draw some limited conclusions.”

Here’s how the numbers added up: 14.5 million of the estimated 40.7 million Americans who were uninsured in 2013 gained coverage, while 5.2 million lost coverage – leaving a net gain in coverage of about 9.3 million. Just 1.4 million of 3.9 million HIX plan enrollees through mid-March said they were previously uninsured, while Medicaid enrollment increased by 5.9 million.

Scandlen, who said that RAND “used to be a reliable source” before issuing an infamous report in 2005 on health care information technology, noted how surveys such as the one conducted by RAND skew results when they regularly poll the same respondents. Carman counters that RAND’s numbers mirror other large surveys about insurance coverage.

RAND respondents included 2,425 adults of the more than 5,000 individuals who participate in occasional online surveys known as the RAND American Life Panel, which researchers describe as “a small but nationally representative sample.”

Scandlen also couldn’t help but reference a disclaimer by the authors who admitted to a margin of error of 3.5 million people. But Carman scoffs at this point, noting how every survey has a margin of error and RAND’s number is so high because it accounts for 2% of the entire U.S. population between the ages of 18 and 64.

Bruce Shutan is a Los Angeles freelance writer.