Census Report Not Enough to Say Healthcare Law Is Working, Yet

Next year's Census report may tell us more about the Affordable Care Act.

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The new Census Bureau report does not necessarily mean the Affordable Care Act is working, despite claims by President Obama's health secretary. The report revealed an uptick from 2009 to 2010 in the number of insured only among 18- to 24-year-olds, the group that benefited from the law's provision allowing children to stay on a parent's insurance plan until age 26. But since that provision was only in effect the last few months of the year, experts say next year's survey will be far more telling.

Though, if opponents have their way, next year's survey won't matter anyway. A Tuesday ruling in Pennsylvania added to the pile of conflicting district court decisions on whether or not the law is constitutional, and the Supreme Court is expected to take up the case before next summer.

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The 2.1 percentage point bump in 18- to 24-year-olds with insurance was the one bright spot in the Census survey, which revealed that compared to 2009, the 2010 median U.S. income dropped, the poverty rate increased, and health insurance coverage overall was stable. But that one bright spot inspired optimism from the Obama administration. "[The] new report shows that the Affordable Care Act is working," Health and Human Services Secretary Kathleen Sebelius blogged on the government's healthcare website, connecting the gains to the new rule extending coverage for young people, which went into effect late last September. "We expect even more will gain coverage in 2011 when the policy is fully phased in," Sebelius wrote.

Not so fast, says Ed Haislmaier, a health policy analyst at the conservative Heritage Foundation. "It's really hard to see how you could reasonably think even more than a quarter of the difference could possibly be attributed to a policy that went in over the last quarter of last year," Haislmaier says. After reviewing the numbers in all the insurance categories—employer-based, direct purchase, Medicaid, Medicare, and military—he's not convinced. The most likely place an increase in kids on their parents' plans would show up is among employer-based, direct-purchase, and military insurance, which increased by 0.6 percentage points, 0.1 points, and 0.4 points, respectively. And since the survey is a national sampling with a margin of error, not a complete national total, Haislmaier doesn't think those numbers are enough to connect the dots to the Affordable Care Act. "If you saw some increase next year, you might have a stronger case to say that that policy was having an effect," he says, adding that 2010's tentative economic recovery or stabilization could account for part of the increase, since perhaps some young people simply got hired. "Come back in a year and we'll see."

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Matt Broaddus, a research associate at the left-leaning Center on Budget and Policy Priorities, agrees that next year's survey will be a better gauge. He says the bump in the number of 18- to 24-year-olds insured in 2010 is statistically significant and "outstanding," but he takes a more cautious approach as to whether or not the Affordable Care Act is responsible. "We don't know for sure," Broaddus says, adding it is likely one of several factors. "Since we're seeing employer-sponsored coverage drop for all the other working age groups, we start to think that this may be related to the healthcare law."

Of course, correlation does not necessarily imply causation, but other evidence does support the theory: In an August survey of employers conducted by consulting firm Mercer, 40 percent of employers reported they saw insurance enrollment grow because of the provision allowing children up to 26 to stay on parents' plans.

Neera Tanden, who oversees the healthcare team at the left-leaning Center for American Progress, believes that the report is a good sign for the program's success. "The only bright spot in this entire Census picture was an increase of insurance among young people," says Tanden, who was on the White House team that helped pass the law. She points out that young people typically have the lowest rates of insurance and the highest unemployment—and no other age group saw gains in coverage. "There's no explanation in the economy of why that would happen other than the Affordable Care Act."