ACA helping more adults to obtain healthcare insurance, surveys find

July 18, 2014

Gains occur across age groups but are greater in states expanding Medicaid coverage

Four-plus years after its enactment, and nine months after the rollout of the healthcare insurance exchanges, evidence is mounting that the Affordable Care Act (ACA) is helping more Americans to obtain insurance coverage for their healthcare.

A quartet of surveys and studies released in recent weeks, while containing somewhat different numbers, all show the number of adults with insurance increasing and the percentage of the population without some form of insurance falling.

At the same time, however, new challenges are emerging related to access to care, while many ACA critics remain unconvinced that the law is having any significant impact.

The Commonwealth Fund, in a study released July 10, finds that the uninsured rate among adults age 19 to 64 declined from 20% in the July to September, 2013 quarter-immediately before the startup of the federal and state insurance exchanges-to 15% in the April to June 2014 time period. The study’s authors estimate that translates into 9.5 million fewer uninsured adults.

A poll released the same day by the Gallup organization, in conjunction with the consulting firm Healthways, shows that the uninsured rate among adults 18 and older declined from 17.1% at the end of 2013 to 15.6% in April 2014 to 13.4% by the end of June. Also on July 10, the Urban Institute’s Health Policy Center published a survey showing that the uninsurance rate for adults age 18-64 dropped from 17.9% to 13.9% between September 2013 and June 2014, or about eight million individuals.

Finally, the authors of a health policy report published in the July 17 New England Journal of Medicine estimates that 20 million Americans have gained coverage since October 1, 2013, a figure that includes young adults who gained coverage under a parent’s insurance policy, people who selected a plan under the insurance exchanges, those who purchased coverage directly from an insurer, and people who enrolled in Medicaid or the Children’s Health Insurance Program (CHIP.)

ACA critics remain unimpressed by gains in coverage, saying that they have come at a substantial cost. “The…argument was never that a trillion or two dollars would never cover any more uninsured,” the Republican pollster Whit Ayres told the website Politico.com. “It was that the cost or dong so in higher health costs and premiums, canceled polices, increased government control of health care…were not worth it.”

            Other findings of note from the surveys:

  • In the states that expanded Medicaid eligibility under the ACA, the uninsured rate for adults with income under 100% of the federal poverty level declined from 28% to 17%, while remaining virtually unchanged (at 36%) in states not expanding Medicaid eligibility, according to The Commonwealth Fund.

  • The overall percentage of adults reporting Medicaid coverage increased from 6.8% during August-September 2013 to 8.4% in the second quarter of 2014, according to the Gallup/Healthways survey

  • Reductions in the number of uninsured occurred across all age groups (18 to 25, 26 to 34, and 35 to 64), according to Gallup/Healthways

  • More than half of adults with new healthcare insurance coverage said their plan included all or some of the doctors they wanted.
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