Fact check: how many lottery winners could lose access to Medicaid?
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Version 0 of 1. Hi there, how are you doing? If you live in the US and you’re concerned about your health insurance, I assume you’ve spent the past few days reading the news nervously. When the Republican healthcare plan was unveiled this week, those who looked at it were less than impressed. Asked if the much-anticipated bill was on the right track, Republican senator Pat Roberts said “it’s on some track”, while Democratic senator Chris Murphy was a little more direct, saying: “This is a dumpster fire of a bill that was written on the back of a napkin.” One of the main goals of the Affordable Care Act, also known as Obamacare, was to improve healthcare for America’s poorest citizens. And it’s those Americans who are most likely to lose out under a new policy. Of virtually no importance whatsoever is the effect of this policy on America’s millionaires. So, why focus this week’s fact check on the wealthy? Well, for two reasons. One, the provision in the draft law that relates to “high dollar lottery winners” seems like a strange way to spill ink (almost six of the draft law’s 66 pages are spent on these Americans). Two, it’s a great way to get to grips with probabilities, a statistical concept you can apply to everything from “Will my health condition still be covered?” to “What are my chances of getting hit by a car?” Let’s start fact-checking this together – how many lottery winners could lose their access to Medicaid? Step 1: Find out how many people in the US are covered right now. Do an internet search for this question but use the term Affordable Care Act rather than Obamacare so that you can focus on academic and governmental studies. You can add “filetype:pdf” to your search in Google if you want to try to limit the results to published reports. I also filter so I can only see results published in the past year – I need recent numbers. I end up clicking on this report by the Centers for Disease Control and Prevention, this country’s public health institute. In terms of national health statistics, it doesn’t get more accurate. Their latest numbers, from 2015, estimate that 18.9% of people aged 18 to 64 have public health insurance (I’m looking at Table 1.2a of this link). Step 2: Check that number. Below 18.9, the report says “(18.23-19.65)”, which means they’re not really sure it’s exactly 18.9% of Americans in that age group – it could be as low as 18.23% or as high as 19.65%. I’m OK with that margin of error. More importantly, the footnote says that the CDC defines public health insurance as including “Medicare (disability), Medicaid, Children’s Health Insurance Program (CHIP), state-sponsored or other government sponsored health plan, and military plans”. So keep in mind that we’re throwing lots of different types of healthcare into this basket, not all of which would be affected by the new policy. Step 3: Find out how many people are lottery winners. I search for things such as “lottery winners US statistics” and end up at sites such as this one. They are rubbish. No sources for your numbers? You’re dead to me. I try to find out how many Americans play the lottery. About 49% of people played the lottery in the past year, according to this study published in 2011 in the Journal of Gambling Studies. The study also found that the share who have played the lottery rises to 61% for the poorest Americans and falls to 42% for the richest.1 OK, that’s a lot of people. Let’s find out what their chances are of winning. Well, there again I hit a bit of a dead end. Strangely enough, most lotteries don’t tell players their chances of winning. But I can tell you about the odds of one type of win – the Powerball jackpot. Because, using some pretty simple math, I can calculate those odds for myself. They’re low. Really low. The odds of winning the Powerball jackpot are about 1 in 292,201,338. Only 192 people in the US have ever won that jackpot since 2003, according to Powerball’s site. Those 192 people, as a share of the 249 million adults who live in the US, is 0.0008%. Are you still with me here? You’re a trooper. Step 4: Find out how many people are lottery winners and have benefited from ACA. Let me use an analogy here. Let’s say you wanted to find the chances of a coin toss landing on heads and a second coin toss on heads too. You simply multiply the chance of throwing a head (which is one in two or 0.5) with the chance of throwing another head (again, 0.5) to get one in four, or 0.25. Let’s do the same thing here. The chances of an American having public health insurance are, very roughly speaking, 18.9 in 100, or 0.189. The chances of winning the Powerball jackpot are (again, very roughly speaking), 8 in 1,000,0000 or 0.000008. To find out the chances of having public health insurance and being a jackpot winner is roughly 0.189 multiplied by 0.000008. That gives you odds of 0.000001512. Which means that about 377 American adults meet both criteria.2 But the analogy with a coin toss isn’t quite right. See, the chances of getting heads on your second coin toss aren’t in any way affected by whether you got heads on your first toss (statisticians call these “independent” events). The chances of winning the lottery and having public health insurance aren’t quite like that. On the one hand, we know that the ACA was supposed to reach the poorest Americans and we know those are also the people most likely to play the lottery. So maybe the odds of falling into both groups are higher than it first seems. On the other hand, people who win huge sums of money might want to spend some of it on private healthcare. That would mean that the odds of being a lottery winner and receiving insurance through ACA are even lower than these numbers suggest. Whatever the case, though, we know that there aren’t that many people at all that fall into both groups. So, spending six pages of a draft bill that could affect the nation’s health by focusing on a couple hundred Americans? Well, that seems strange to say the least. 1 I’m trying footnotes! While we’re on the subject of the poor, it might be worth mentioning this Google result I bumped into – a study by three economists that used 10 years of data from 39 states and found a “strong and positive” correlation between lottery ticket sales and poverty rates. 2 Weeell, maybe. The probabilities I’m using here are about slightly different groups. There’s the population that the CDC uses (everyone age 18 to 64) and there are those who play the lottery (in most states you have to be 18 or over but there’s no upper age limit). And don’t forget, I’m only talking about the Powerball here. The chances of winning are much higher if you include state lotteries too. Would you like to see something fact-checked? Send me your questions! mona.chalabi@theguardian.com / @MonaChalabi |