Sizing up the Sharp Drop in the Uninsured Rate
Now that the last significant lawsuit challenging the federal health care reform law has been turned aside, it’s clear that the Affordable Care Act is the law of the land. However, that fact will generate more debate in Congress about the law, as its opponents turn more attention to trying to repeal the ACA.
While that debate heats up, we need to look objectively at the evidence regarding the law’s effects – starting with the effect on insurance coverage. In this blog post I’ve pulled together the best available survey data regarding the effects of the ACA on the number of Americans and Wisconsinites who are uninsured.
A quarterly national survey by Gallup shows quite clearly that the health care reform law has very substantially reduced the number of uninsured, but not nearly as much in the states that have expanded Medicaid eligibility (to 133% of the federal poverty level) as in the states like Wisconsin that have not done so. The following statistics are from a recent analysis of the Gallup data by the Health Policy Center at the Urban Institute. Their recent report concluded that:
- The portion of non-elderly adults with insurance grew from 82.4% in Sept. 2013 (which was just before the initial Marketplace open enrollment period) to 89.9% in early March 2015, which was just after the second open enrollment period.
- To put it a little differently, the uninsurance rate for nonelderly adults fell from 17.6% to 10.1% over that period, a drop of 7.5 percentage points.
- That represents an increase of about 15 million non-elderly adults with insurance over the course of the year and a half period that they focused on(which doesn’t include an earlier increase of about 2.3 million young adults with insurance, due to the ACA provision enabling adults under age 26 to remain on a parent’s plan).
- In states that expanded Medicaid by March 2015, the uninsurance rate fell by more than half (52.5%), from 15.8% to 7.5%. In states that did not expand Medicaid, the uninsurance rate decreased from 20.7% to 14.4%, a decline of 30.6%.
The state-level figures aren’t as current and are a bit less clear. The first survey I’ve seen with Wisconsin-specific data was released by the National Center for Health Statistics (NCHS) a couple weeks ago, and it compares the average insurance rate in 2014 with the average in 2013. As the following bar graph illustrates, that data indicates that Wisconsin’s 1.9 percentage point gain in insurance coverage for the non-elderly population (0-64) was only about half the improvement in the Medicaid expansion states, and also trailed the average gain in the other states that haven’t expanded Medicaid. On the positive side, Wisconsin continues to have one of the lowest uninsurance rates.
I’m looking forward to seeing better state-level data for 2014 when the results of the Census Bureau’s American Community Survey are released in September. There are a number of shortcomings of the NCHS survey — particularly the fact that a relatively small sample size for each state creates a substantial margin of error in the data, which makes comparisons to other states problematic. Also, the timing of the survey over all 12 months of 2014 means that the survey doesn’t fully reflect the insurance gains in the second half of the year, much less any of the improvement this year.
Based on a combination of survey data and administrative enrollment numbers, I think it’s pretty clear that there has been a very substantial reduction in the number of uninsured Wisconsinites. In addition, I suspect that it’s true that we are significantly trailing the Medicaid expansion states; however, it’s too soon to say with any certainty how much the insurance rate has improved in our state and whether we trail the average for non-expansion states.
Although the state-specific data is still somewhat fuzzy, the national findings are very clear. The ACA has been very effective in reducing the number and percent of uninsured Americans, and those gains will continue to grow as more states expand Medicaid and as more people continue to sign up for Marketplace insurance plans.