Surveys Highlight ACA’s Effect on U.S. Uninsured Rate

A series of new surveys show the initial effect the Affordable Care Act has had on the uninsured rate since the law's insurance exchanges launched in October 2013, the Washington Post's "Wonkblog" reports.

For example, one Gallup survey released last week showed that 17.1% of the population was uninsured during the last quarter of 2013, compared with 15.6% in the first quarter of 2014, the lowest uninsured rate in the U.S. since 2008 (Millman, "Wonkblog," Washington Post, 4/16). The data mean that around 7.26 million U.S. residents who were uninsured in September 2013 now have coverage.

Uninsured Rates Drops Faster in ACA-Friendly States

Meanwhile, another Gallup poll released Wednesday and research from the Urban Institute and Robert Wood Johnson Foundation released Wednesday show that uninsured rates have dropped nearly three times faster in states that have embraced ACA reforms than in those that have decided not to run their own insurance exchanges or expand Medicaid under the law.

The Gallup survey is based on daily polls it conducted beginning March 4 that included responses from more than 20,000 adults (Ritger, National Journal, 4/16).

According to the UI/RWJF poll, the number of uninsured non-elderly U.S. adults dropped by 5.4 million people between September 2013 and early March 2014. In addition, the poll found that uninsured rates dropped by 4% in states that expanded their Medicaid programs under the ACA, while it declined by 1.5% in states that did not expand Medicaid ("Wonkblog," Washington Post, 4/16).

Specifically, uninsured rates fell from 16.1% at the end of 2013 to 13.6% in the beginning of 2014 in the 21 states that expanded Medicaid and are operating their own insurance exchanges either in full or in part. In comparison, states that have not done so saw uninsured rates drop from 18.7% to 17.9% in the same period (Levey, "Politics Now," Los Angeles Times, 4/16).

Further, the poll showed states with expanded Medicaid programs were more effective in covering Hispanics and young adults.

However, "Wonkblog" notes that the UI/RWJF survey data come with some caveats. For example:

• The data do not include information on enrollment during the last few weeks of March; and
• The survey's margin of error accounts for about 2.2 million people ("Wonkblog," Washington Post, 4/16).

Overall, Gallup's results suggested that an additional four million people have enrolled in some type of coverage in the last few weeks of the ACA's open enrollment period. Gallup Research Director Dan Witters noted, "It is fair to say [the ACA] is having a significant impact."

According to "Politics Now," the data do not separate those who gained coverage through the exchanges from those who gained other types of insurance. The data also do take into account coverage losses that could have resulted from previous plans not meeting the ACA's basic coverage standards ("Politics Now," Los Angeles Times, 4/16).

Newly Insured Mostly Younger

Another Gallup survey released Wednesday found that the proportion of newly insured individuals skews younger, National Journal reports (National Journal, 4/16).

According to the poll, 4% of U.S. residents claim to be newly insured this year, including 2.1% who reported gaining coverage through the ACA's exchanges. The remaining individuals said they gained coverage from a different source, which could include Medicaid, employer-sponsored health coverage or a private insurer. In addition, another 7.5% of people said they signed up for a new health plan to replace one they already had.

Of those who said they are newly insured, 30% are between the ages of 18 and 29, representing 21% of the population, according to the poll. However, Gallup noted that such individuals were more likely to have signed up for private coverage, at 37%, than to have enrolled in plans through the ACA's exchanges, at 24% ("Wonkblog," Washington Post, 4/16).

The poll also found that newly insured residents are relatively as healthy as the general population, according to respondents' self-reported health status ("Politics Now," Los Angeles Times, 4/16).

The survey also found that people's political ideologies affected whether they enrolled in exchange coverage. According to the poll, Republicans comprised 24% of the newly insured, while Democrats accounted for 54% of the group. Further, newly insured Republicans were less likely to enroll exchange coverage than newly insured Democrats (National Journal, 4/16).

The findings are based on monthly surveys Gallup conducts which include around 14,800 U.S. adults ("Politics Now," Los Angeles Times, 4/16).

More People Likely To Purchase Coverage When Penalties Rise

In related news, an additional Gallup survey released Wednesday shows that individuals will be more likely to purchase health coverage as penalties for being uninsured under the ACA's individual mandate increase, The Hill's "Healthwatch" reports.

According to the poll, which is based on interviews conducted with 43,562 individuals throughout the year, 46% of people would rather pay a fine instead of purchasing insurance if the penalty totals $95. Meanwhile, 32% of people said they would rather pay the penalty if it increases to $500. Further, 28% said they would defer purchasing coverage and pay the fine if it reached $1,000 (Trujillo, "Healthwatch," The Hill, 4/16).