Bill of health

By C.H. | NEW YORK

IF DEMOCRATS and Republicans can agree on one thing, it is that Obamacare is hugely important. Democrats say it is a boon, Republicans that it amounts to the apocalypse. But knowing precisely what Obamacare does is rather difficult. The law’s knock-on effects—on the broader economy, on health-care businesses and on health, such as its effect on heart disease or cancer—may never be precisely quantified. It is even difficult to measure Obamacare’s progress towards its main goal, expanding insurance. Gallup, a pollster, is the latest group to make the attempt, presenting new data on April 16th.

The figure, if it could be precisely measured, would show how many people Obamacare has benefited. It would also help Democrats argue that Obamacare is a success or add fuel to Republicans’ fiery proclamations that it is a disaster. Changes in how the Census measures insurance will make it harder to quantify exactly how many people have gained coverage. Not surprisingly, however, both the health department and independent researchers continue to produce their own estimates. Importantly, the survey from Gallup is larger than those of many competitors—the company interviews about 15,000 Americans about their health each month.

Obamacare has been implemented in a strange context. Gallup shows how the share of Americans without insurance had been rising, with only a few dips, since 2008. In the third quarter of 2013, just before Obamacare began enrolling Americans in new coverage, the uninsurance rate had climbed to 18%. It has fallen precipitously since then, to 15% in March. And according to Gallup’s data for the first half of April, that share has since dropped to 12.9%, lower than at the start of 2008. Gallup’s best guess is that a net of 7.26m Americans have gained insurance since the third quarter of last year.

Progress has been uneven. Black Americans gained coverage at the fastest clip: the rate of uninsured fell from 20.9% in the third quarter of 2013 to 17.6% in the first quarter of this year. The share of uninsured Hispanics fell from 41.4% to 37%.

There were also dramatically different results in states that shunned Obamacare and in those that expanded Medicaid, the health programme for the poor, and helped run their own insurance exchanges. Enthusiastic states began with a smaller share of uninsured adults. But they also saw a bigger drop. In the first quarter of this year, the share of uninsured adults in the obstinate states was 17.9%, compared with 13.6% in the supportive ones.

Two findings are particularly important. First, Gallup estimates that 11.8% of American adults got a new insurance plan this year. However, only about one third of these were previously uninsured. The second concerns the age and health of the newly insured.

In the list of ominous predictions about Obamacare, a main fear has been that only sick people will sign up. This would prompt insurers to raise prices, making healthy people even less likely to enroll (the dreaded death spiral). However, Gallup reported that the newly insured are not more or less sickly than the general population. Furthermore, new enrollees are disproportionately young: those aged 18-29 comprise 30% of the newly insured, compared with 21% of the broader adult population. There is no magic number of young, healthy enrollees that will make Obamacare succeed. But a death spiral seems unlikely.

Both political parties will mine Gallup’s data to support their argument. Republicans will likely highlight evidence that Americans are simply switching from one health plan to another. Democrats will point triumphantly to the number of young people signing up. Not surprisingly, the main determinant of whether a voter favours Obamacare is not his age, race, education or income, but his political party.