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State of the Union: Fact checking Obama on the ACA

President Barack Obama delivers the State of the Union address at the U.S. Capitol in Washington on January 28, 2014.

"More than 9 million Americans have signed up for private health insurance or Medicaid coverage," President Obama said during last night's State of the Union address. In a speech that touched on income inequality, wages, jobs, and the U.S. middle class, Obama touted his signature domestic policy achievement. But is that 9 million figure accurate?

You can slip into quicksand really fast, if you're trying to figure out just how many people have signed up for health insurance under the Affordable Care Act. Technically 9 million is accurate. About 3 million people have enrolled through the federal or state health exchanges, and about 6 million have signed up for Medicaid, the program that's primarily for low-income Americans.

But -- and here's the thing to remember -- insurance isn't static. People are signing up, and re-enrolling all the time. So 9 million doesn't mean 9 million new people have signed up. Undoubtedly, some of those people, particularly those who signed up for Medicaid, are getting access due to the Medicaid expansion. But we don't know how many, and we won't know for several more months.

Another thing that's unclear is how many people who weren't covered before the Affordable Care Act was passed are covered now. The thought is that 16-17 million uninsured people will get coverage through the exchanges or Medicaid by the March 31 enrollment deadline. 

Earlier this month, a survey came out from McKinsey & Co. showing that only 11 percent of people who bought policies on the exchanges were previously uninsured. But those numbers are not confirmed.

Another goal of the ACA was, as Obama put it last night, protecting people financially so "if misfortune strikes, you don't have to lose everything." While the ACA does provide more consumer protections, Obama's assertion could use some context.

There are now protections like out-of-pocket maximums for how much you will have to pay if things get really bad. While the maximum for an individual is about $6,000 and about $13,000 for a family plan, caps don't apply if you see a doctor who isn't in the network included in the insurance plan you have.

We all know health care is quite complicated. And consumers -- especially people new to health insurance -- have to make sure they understand how it works.

About the author

Dan Gorenstein is the senior reporter for Marketplace’s Health Desk. You can follow him on Twitter @dmgorenstein.

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