NOTE: I’m very much aware that this is likely to turn into another Bernie/Hillary slugfest, and this time I’m gonna embrace that (though I can’t guarantee that I’ll respond to too many comments).
I’m presenting the following not as a way of influencing people one way or the other, because in many ways it illustrates both perspectives: The absurd complexity of the current system (Single Payer Rox!!) and how incredibly difficult it will be to replace it (Step by Step, Folks!!). Depending on your POV, you could use this to make your case either way.
Having said that:
I tried doing this last July, and while I obviously was off a bit here and there, overall I think I got it pretty close. It's time to give it another shot.
The pie chart above is my best attempt to summarize the current (as in, March 2016) total U.S. healthcare coverage landscape. Due to differences in timeframe, methodology and so forth, this is sort of a composite/blended picture based on hard numbers and surveys from official government sources (HHS Dept, CDC, CBO, Census Bureau, etc) as well as respected 3rd-party outlets (Kaiser Family Foundation, Urban Institute, etc). I didn't include specific links to reports because 1) again, these are composite numbers which likely won't always line up precisely with any specific reports and 2) most of them can be found by hunting around ACASignups.net anyway.
One important thing to note: Total Medicaid/CHIP enrollment as of November 2015 was around 71 million (and is presumably a bit higher now), yet I have it down as only 63 million. The "missing" 8 million are "dual eligibles"...enrolled in both Medicaid and Medicare simultaneously. I wasn't sure how to handle these, so I lumped them in with Medicare instead (and I'm not even sure how many of them are over/under 65).
In case it’s hard to read, the first 14 sections represent different types of healthcare coverage. This includes private insurance (Employer-Sponsored, Off-Exchange Individual, etc), public coverage (Medicare, Medicaid, S-CHIP, the ACA’s BHP program, the VA/TriCare, etc) and policies which could be defined as public/private hybrid (the ACA exchange policies, government employee plans and so forth).
The remaining 6 sections represent the different categories of uninsured people: Those eligible for (but not enrolled in) Medicaid/S-CHIP; those caught in the Medicaid Gap; Undocumented Immigrants; those eligible for ACA subsidies who haven’t signed up yet; and those who would have to pay full price if they did sign up.
The thing is, even these 20 sections are just the beginning...because each of those slices further breaks down into multiple sub-categories. There are different types of Medicare (Original, Advantage, Supplemental). There are different types of Medicaid depending on what state you live in (there’s 8 different income categories in non-expansion states depending on whether you’re a pregnant woman, newborn, toddler, teenager, etc). And of course on the private side, there are countless variations on carriers, Metal Levels, PPOs vs HMOs, bla bla bla.
Again, I can't stress this enough: The numbers for some of the individual sections may be off somewhat due to the difficulty of wrestling some of the data to the ground, but I think that this is a reasonably good overall picture of the current situation. This is not intended to be a precise measure, just to give a general sense of where things are at.
Assuming our healthcare panel does end up being included at this summer’s #NetrootsNation, consider this to be a simple preview of the discussion.
UPDATE: As a sort of companion piece, I also did the same “rough visualization” thing showing how the individual health insurance market has changed over the past 3 years.