ACA leading to huge drop in uninsured rate

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Obamacare effects are bigger than expected, poll finds


By Noam Levey
5:56 PM PDT, April 16, 2014

WASHINGTON — President Obama's health law has led to an even greater increase in health coverage than previously estimated, according to new Gallup survey data, which suggests that about 12 million previously uninsured Americans have gained coverage since last fall.

That is millions more than Gallup found in March and suggests that as many as 4 million people have signed up for some kind of insurance in the last several weeks as the first enrollment period for the Affordable Care Act drew to a close.

Just 12.9% of adults nationally lacked coverage in the first half of April, initial data from the Gallup-Healthways Well-Being Index indicate. That's the lowest rate since the survey began in 2008.

Eighteen percent were uninsured in the third quarter of 2013, just before Americans could start shopping for coverage on the new online marketplaces created by the law.

Gallup pollsters cautioned that the data are preliminary but said it is increasingly clear the health law is responsible for the gains. "It is fair to say it is having a significant impact," said Dan Witters, the survey's research director. Critics of the law, sometimes called Obamacare, say it has done little to expand health coverage.

Gallup's latest data, which parallel recent findings from Rand Corp. and the Urban Institute, lump together all coverage gains, including those on the marketplaces, as well as through other forms of insurance, such as Medicaid, employer-provided coverage and health plans purchased directly from insurers.

The data also take into account any losses in coverage the law may have brought about by the cancellation of health plans that did not meet new standards.

The health law enables Americans who do not get coverage through an employer to select a plan on government-run marketplaces. Insurers must offer a basic set of benefits and can no longer turn away sick customers.

Americans making less than four times the federal poverty level — about $94,000 for a family of four — qualify for government subsidies in most parts of the country.

In about half the states, very low-income Americans can sign up for Medicaid. Most Republican-led states, however, have not expanded the program to cover all low-income residents, an option provided by the health law. The disparity between states that have embraced the health law and those fighting it is already showing up in health coverage, Gallup found.

From 2013 to the first quarter of 2014, the uninsured rate fell to 13.6% from 16.1% in the 21 states that are expanding Medicaid and are fully or partially operating their own marketplaces, rather than deferring that job to the federal government. The uninsured rate dropped about a third as much in the states that have not fully embraced the law, to 17.9% from 18.7%, the poll found

"The gap is widening," Witters said.
The Obama administration reported last week that 7.5 million people have signed up for coverage through the marketplaces.
Not all of these people were previously uninsured, however. Some probably had coverage through an employer. Some may have bought insurance directly from an insurance company. Others may have been on government programs, such as Medicaid.

Gallup's polling does not clarify how many of the 7.5 million were previously uninsured, nor does the survey identify whether the newly insured got coverage on a marketplace or through other avenues, such as Medicaid or an employer.

The new data do provide some new insights into who the newly insured are, however. They appear to be slightly younger than the population at large, with two-thirds ages 18 to 49, compared with 55% of the population at large.

And they are about as healthy as the general population, according to self-reported health status.
The newly insured also seem to reflect the nation's deep political divide over the health law; 54% are Democrats, while just 24% are Republicans.

Frank Newport, Gallup editor in chief, said that suggests Americans' political leanings may be influencing their decisions about whether to get health insurance. Gallup has found that although about 3 in 4 Democrats approve of the health law, just 1 in 6 Republicans do.

Gallup interviews about 14,800 adults a month nationwide for the Gallup-Healthways Well-Being Index, making it one of the largest health insurance surveys in the nation.

[Admin]

In the end, was this really worth closing the government for or even threatening to default on US debt?

Major New Study Says Obamacare Is Working — Even For Republicans

The Affordable Care Act has been successful at achieving some major goals in the first year of its full implementation, according to a new study from The Commonwealth Fund.

There are three important findings from the study: The uninsured rate is dropping, most people like their new insurance plans (even Republicans!), and most people are finding it easy to visit a doctor.

The study found the uninsured rate in the U.S. declined by one-quarter over the last nine months, which included the law's first, six-month open-enrollment period in which individuals could sign up for private insurance plans through exchanges established by the law.

From the July-to-September 2013 period to the April-to-June 2014 period, the uninsured rate of people between the ages of 19-64 dropped from 20% to 15%, according to the study. The research found 9.5 million people gained insurance, either through the exchanges or through the law's expansion of the federal Medicaid program.

The decline in uninsured was seen across different age groups and races, though the drop was disproportionately high among the young (-10%) and Latinos (-13%). It was disproportionately low among African-Americans — the decline was only 1%.
The findings show the law has been successful at reducing the uninsured rate among the poor — which was, of course, one of its main goals:

The Commonwealth Fund

Expectedly, there is a significant difference in the reduction of uninsured between states that have expanded Medicaid and those that have not. According to the study, the uninsured rate among residents who make up to 100% of the federal poverty level fell from 28% to 17% in the 25 states that have expanded Medicaid (plus the District of Columbia). In the 25 states that haven't, the rate only fell from 38% to 36%. 

Among those who have become newly insured, the vast majority say they are "better off" and like their plans. In total, 58% of respondents with new plans said they are "better off" than before — including 61% who were previously uninsured. Seventy-nine percent of those who were previously uninsured said they were either "somewhat" or "very satisfied" with their new plans.
Even 74% of Republicans say they're at least somewhat satisfied with their new plans.

Significantly, most people who gained coverage under the Affordable Care Act said they couldn't have accessed care they have received since obtaining insurance:

The Commonwealth Fund

Finally: About one-fifth of people who have signed up for a new plan have attempted to find a new primary care or general doctor, and most — 75% — have said the process is at least "somewhat easy." Two-thirds of those who found a primary-care doctor got an appointment within two weeks. Thirty-seven percent of people said their new plans included "most" of the doctors they wanted (about 39% don't yet know).

[Admin]

1. Increasing access to the uninsured. 

The law was never going to ensure that every single American had insurance. President Obama promised, in the face of political pressure, not to extend its coverage to non-citizens, who make up about one fifth of the uninsured population. Five* Supreme Court Justices decided to allow states to boycott the law’s Medicaid expansion, adding some 4 million more to the ranks of the uninsured. Also, any new law takes years to ramp up participation and public awareness.

Conservatives widely denied that the law would even succeed at its basic goal of increasing access to health insurance. Obamacare “created more uninsured people than it gave insurance to. And it promises to create even more,” argued National Review’s Jonah Goldberg. Fox News panelist Charles Krauthammer proclaimed the law would result in “essentially the same number of uninsured.”

Every serious method of measuring has shown the law effecting significant reductions in the uninsured rate. The latest, a report by the Urban Institute yesterday, shows that the uninsured rate has fallen nationally by 30 percent:



That rate is 36 percent in states participating in the Medicaid expansion. The states whose Republican governors or legislators have boycotted the expansion have seen their uninsured rates fall by just 24 percent, dragging down the average.

[Admin]

Last year, CBO estimated that an average of 14 million low-income Americans would rely on the Medicaid expansion for coverage over the next decade. Now the forecasting agency expects that the program will have an average enrollment of 18 million. More Medicaid enrollees means more federal spending; the additional 4 million Medicaid patients are expected to drive up the cost of the insurance expansion by $146 billion. At the same time, expected enrollment in the marketplaces declined by 3 million, reducing spending on that private insurance program by $46 billion.

A Supreme Court decision made the Medicaid expansion optional, and 19 states (including some very large ones, like Texas and Florida) have chosen not to participate. The Kaiser Family Foundation estimates that about 2.9 million low-income adults live in states that have not expanded coverage, and thus cannot gain coverage. Those are 2.9 million people that forecasters thought would be eligible for coverage when they drew up that original set of numbers.

Second: CBO now thinks that even with nearly half the states not participating, more people will sign up for Medicaid. The new figures estimate that, on average, the Medicaid expansion will cover 18 million people annually over the course of the next decade. Think about that for a moment: The Medicaid program is operating in significantly fewer states, but covering millions more people. This means the original forecasts seem to have missed how appealing the Medicaid expansion would be. How forecasters — and journalists — got Medicaid wrong In hindsight, it's actually pretty easy to see why Medicaid ended up getting such high enrollment: The program provides relatively comprehensive coverage at very little cost to the enrollee.

Obamacare is doing way more to help the poor than anyone expected - Vox

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From Business Insider:

America's most vulnerable residents have made the biggest gains under Obamacare

• Michelle Mark
  
  
• 3m
  

Cathey Park of Cambridge, Massachusetts shows her cast signed by U.S. President Barack Obama after he spoke about health insurance at Faneuil Hall in Boston Oct. 30, 2013.

See Also

One Of The Biggest Misconceptions About Obamacare Is That It Will Cover Everyone

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Immigrants, low-income workers and racial minorities saw big gains in health care coverage in 2014, the first full year in which the Affordable Care Act was in effect, aNew York Times analysis revealed Tuesday.

Nearly one-third of the newly insured adults were Hispanic, and coverage rates soared for low-wage workers such as cooks, hairdressers, and cashiers.

Immigrants — including more than one million non-citizen residents — saw the largest surge in coverage rates, the Times reported.

The health care law’s effectiveness has typically been measured by the amount of newly insured people, which was last tallied at 20 million as of February 2016.

The Times analysis, which examined 2014 census data, determined the demographic breakdown of the newly insured.

“The law has clearly reduced broad measures of inequality,” Harvard economics professor David Cutler, who was an adviser to President Obama during the 2008 campaign, told the Times. “These are people who blend into the background of the economy. They are cleaning your hotel room, making your sandwich. The law has helped this population enormously.

Two-thirds of the country’s newly insured adults were minorities. Of the 1.2 million non-citizens who gained coverage, 60 percent were Hispanic and around one-third were Asian. The law also helped cover high rates of part-time workers and residents with only a high school education.

The Times’ findings are significant given the context of 2016’s election, as both parties vie for Hispanic and minority votes. The health care law — which passed in 2010 without the help of Republicans and was later upheld by the Supreme Court in 2012 and 2015 — remains a hotly disputed piece of legislation which each of the Republican presidential candidates have promised to repeal.

Supporters of the Affordable Care Act celebrate after the Supreme Court up held the law in the 6-3 vote at the Supreme Court in Washington June 25, 2015.

The law still has hurdles to clear. Some Americans still cannot afford coverage, and the Pew Research Center’s Mark Hugo Lopez told the Times that the vast majority of the country’s 11 million undocumented immigrants remain uninsured.

Furthermore, 19 states have refused to expand their Medicaid programs to cover the poor, as per the Supreme Court’s 2012 ruling. This disproportionately affected the coverage rates of black residents, the majority of whom live in those states that have refused the expansion, according to the Pew Charitable Trusts.

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Some reason for celebration. Since the ACA was introduced, there are 20M less people uninsured.

This issue brief reviews the most recent survey and administrative information available about gains in health insurance coverage since the enactment of the Affordable Care Act (ACA) in 2010. We estimate that the provisions of the ACA have resulted in gains in health insurance coverage for 20.0 million adults through early 2016 (through February 22, 2016), a 2.4 million increase since our previous estimate in September 2015.

Health Insurance Coverage and the Affordable Care Act, 2010 - 2016 | ASPE

The number of uninsured persons has declined in the past year. In 2015, 28.6 million persons of all ages (9.1%) were uninsured at the time of interview—7.4 million fewer persons than in 2014. 

CDC.gov (pdf)

That 9.1% of uninsured is a little over half what it was pre-ACA

The initial National Health Interview Survey results published last month by the Centers for Disease Control and Prevention confirm what many private surveys have shown: that the proportion of Americans under 65 who lack health insurance has plummeted to record lows since the Affordable Care Act became law. Twenty million fewer Americans were uninsured in the first nine months of 2015 than in 2010. The proportion of Americans with private coverage stands at 65.9%, the highest level since 2007.

As the Number of Uninsured Falls, Potential Fallout to Repealing the ACA Grows - Washington Wire - WSJ

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This issue brief reviews the most recent survey and administrative information available about gains in health insurance coverage since the enactment of the Affordable Care Act (ACA) in 2010. We estimate that the provisions of the ACA have resulted in gains in health insurance coverage for 20.0 million adults through early 2016 (through February 22, 2016), a 2.4 million increase since our previous estimate in September 2015. These estimated health insurance coverage gains are shared broadly across population groups. Our estimate of a net reduction of 20.0 million uninsured adults is based on data from the National Health Interview Survey and from the Gallup-Healthways Well-Being Index. Other federal and non-governmental surveys of health insurance status show similar trends over this time period.

Health Insurance Coverage and the Affordable Care Act, 2010 - 2016 | ASPE

An estimated 20 million people have gained insurance since health care reform was signed into law in 2010, but in the six years since, a significant group of Americans remain uninsured. Estimates vary, but as many as 29 million Americans ­– about one in 10 – lack coverage. Why is that? One of the biggest factors is cost, which still hinders many Americans from purchasing insurance. It may seem obvious, but the data shows many of the uninsured can’t afford coverage, even after reforms were passed.

Even With Obamacare, 29 Million People Are Uninsured: Here’s Why | The Fiscal Times