NEW YORK — At the close of the Affordable Care Act’s first open enrollment period, an estimated 9.5 million fewer U.S. adults were uninsured, according to a new Commonwealth Fund survey released last week. The national uninsured rate among working age-adults dropped from 20% in July–September 2013 to 15% in April–June 2014.
Most people with new coverage, either a marketplace plan or Medicaid, said they were optimistic that it would improve their ability to get health care. A majority of those who had used their new plan to get care or fill a prescription said they would not have been able to do so before.
The largest gains in coverage were experienced by young adults ages 19 years to 34 years, whose uninsured rate fell from 28% to 18%; Latinos, whose rate declined from 36% to 23%; and low-income adults, whose rate dropped from 35% to 24%.
In states that expanded eligibility for Medicaid, uninsured rates among low-income adults fell substantially. But in states that did not expand Medicaid, uninsured rates for people under the poverty level remained largely unchanged; these rates were double those of states that expanded. A large portion (42%) of new Medicaid enrollees were young adults 19 years to 34 years. This was the largest share of any adult age group.
As many as 63% of adults with new coverage through the marketplaces or Medicaid had been uninsured previously.
“This is the first survey to look at both coverage trends [and] people’s experiences using their new insurance," said Sara Collins, lead survey researcher and VP healthcare coverage and access for The Commonwealth FUnd. "The findings suggest that the Affordable Care Act is beginning to achieve its central goal — reducing the number of Americans who are uninsured and improving access to health care,” she said. “Adults who are being helped the most are those who historically have had the greatest difficulty affording health insurance and getting the care they need.”
The Commonwealth Fund’s Affordable Care Act Tracking Survey interviewed 4,425 working-age adults nationally about their health insurance status, awareness of the marketplaces and enrollment in both private plans and Medicaid. The survey also asked adults with new insurance to report on their views of and experiences with their coverage.
Highlights of the report, "Gaining Ground: Americans’ Health Insurance Coverage and Access to Care After the Affordable Care Act’s First Open Enrollment Period," include:
- As many as 43% of adults potentially eligible for coverage had visited the marketplaces by early June 2014, up from 24% in December. Of those, 51% selected a private plan or enrolled in Medicaid;
- By the beginning of June, 60% of adults with new coverage said they had used their plans to go to a doctor or hospital or fill a prescription. Of those, 62% said they would have not have been able to afford or access this care prior to getting their new insurance;
- More than half of adults (54%) with new coverage said their plan included all or some of the doctors they wanted. More than three of five adults with new coverage who found primary care doctors were able to get an appointment within two weeks; and
- 81 percent of those with new coverage were optimistic their insurance would improve their ability to get the care they need. And 58% of adults with new insurance said they were better off now than before they had their coverage.
“Health insurance coverage is the critical first step to getting people in the door for needed care,” said Commonwealth Fund president David Blumenthal. “It is clear the Affordable Care Act is already helping improve the lives of millions of Americans. Now we have to make sure that our healthcare system is working smartly and delivering the best care in the most efficient way possible.”
Uninsured rates for low-income adults declined most dramatically in the District of Columbia and the 25 states that expanded their Medicaid programs, falling from 28% to 17% among people with incomes under the poverty level. In contrast, uninsured rates for low-income people remained fairly constant in the 25 states that did not expand Medicaid, with more than one-third (36%) remaining uninsured.
The report analyzed trends in uninsured rates in the six states with the largest populations. Enrollment rates varied, likely due to states’ efforts, as well as their decisions to expand Medicaid. In California, which pursued an aggressive outreach and enrollment campaign and expanded its Medicaid program, the uninsured rate for all working-age adults fell by half, from 22% prior to open enrollment to 11% by early June 2014. In Texas, which did not expand Medicaid, the uninsured rate for adults at all income levels fell from 34% prior to open enrollment to 22% by early June, while in Florida, which also did not expand Medicaid, the slight decline in the rate, from 30% to 26%, was not statistically significant. The current uninsured rates in Florida and Texas are statistically the same with both states continuing to leave uninsured the largest share of their adult population of the six largest states.