By: Kenneth Finegold and Munira Z. Gunja
The Affordable Care Act’s Health Insurance Marketplace coverage became available on January 1, 2014, and its Federally-financed, state-optional, Medicaid expansion started on the same day. Since then, millions of Americans have gained coverage through each of these sources, and total insurance coverage has expanded markedly. All told, estimates based on data from the Gallup-Healthways Well-Being Index (WBI) suggest that 10.3 million previously uninsured nonelderly adults (ages 18 to 64) gained coverage under the Affordable Care Act through June 2014.1 This estimate includes the effect of the surge in Marketplace enrollment in late March, at the end of the open enrollment period, as well as Medicaid/CHIP growth through June.
- As of June 2014, 10.3 million nonelderly adults (ages 18-64) gained health insurance coverage since the start of the Affordable Care Act initial open enrollment period in October 2013.
- The uninsured rate among nonelderly adults fell by more than a quarter (26 percent), from 20.3 percent to 15.1 percent, comparing numbers as of June 2014 with the January 2012-September 2013 baseline period. African Americans and Latinos saw particularly large drops in their uninsured rates of 6.8 percentage points and 7.7 percentage points, respectively.
- Government and private surveys offer a consistent picture of expansions in insurance coverage.
The 2014 reduction in the number of uninsured adults builds on earlier effects of the Affordable Care Act on health insurance coverage. Nearly 950,000 individuals in six states (California, Colorado, Connecticut, Minnesota, New Jersey, and Washington) and the District of Columbia gained coverage before January 1, 2014 from early Medicaid expansions under the Affordable Care Act.2 And an estimated 3.1 million young adults gained coverage under a parent’s employer-sponsored or individual market plan under the Affordable Care Act’s expansion of dependent coverage, which was effective for plan years beginning on or after September 23, 2010.3
The Gallup-Healthways WBI survey data represent the most up-to-date information on insurance coverage since the start of the Affordable Care Act’s coverage expansion. However, federal surveys have also recently released estimates on insurance coverage; in September, the National Center for Health Statistics (NCHS) released data for January-March 2014, and the Census Bureau released data for Calendar Year (CY) 2013. These surveys provide the best information available to date on health insurance coverage during the periods they cover.4 The federal surveys have large sample sizes, high response rates, rigorous quality assurance procedures, and methodologies that are continually being improved through statistical analyses, cognitive interviewing, and field tests of alternative approaches.
Unfortunately, the data from government surveys released to date either provide no information on 2014 or end too early in 2014 to capture the surge in enrollment that occurred at the end of the first Marketplace open enrollment period. When federal survey data for the whole of 2014 become available, it will be possible to more fully assess the impact of the Affordable Care Act’s coverage expansion.
1 Benjamin D. Sommers, Thomas Musco, Kenneth Finegold, Munira Z. Gunja, Amy Burke, and Audrey McDowell, “Health Reform and Changes in Health Insurance Coverage in 2014,” New England Journal of Medicine, July 23, 2014 (http://www.nejm.org/doi/full/10.1056/NEJMsr1406753, accessed October 27, 2014).
2 Centers for Medicare & Medicaid Services, Center for Medicaid & CHIP Services, Medicaid & CHIP: August 2014 Monthly Applications, Eligibility Determinations and Enrollment Report, October 17, 2014 (http://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Downloads/August-2014-Enrollment-Report.pdf, accessed October 27, 2014). See also Benjamin D. Sommers, Emily Arnston, Genevieve M. Kenney, and Arnold M. Epstein, “Lessons from Early Medicaid Expansions Under Health Reform: Interviews with Medicaid Officials,” Medicare & Medicaid Research Review 3:4 (2013) (http://www.cms.gov/mmrr/Downloads/MMRR2013_003_04_a02.pdf, accessed October 27, 2014); and Benjamin D. Sommers, Genevieve M. Kenney, and Arnold M. Epstein, “New Evidence on the Affordable Care Act: Coverage Impacts of Early Medicaid Expansions,” Health Affairs 33, no. 1 (2014): 78-87.
3 Benjamin D. Sommers, “Number of Young Adults Gaining Insurance Due to the Affordable Care Act Now Tops 3 Million,” ASPE Issue Brief, June 19, 2012 (http://aspe.hhs.gov/aspe/gaininginsurance/rb.pdf, accessed October 27, 2014). See also Andrew Mulcahy, Katherine Harris, Kenneth Finegold, Arthur Kellermann,, Laurel Edelman, and Benjamin D. Sommers, “Insurance Coverage of Emergency Care for Young Adults under Health Reform,” New England Journal of Medicine 368:2105-2112 (May 30, 2013), DOI: 10.1056/NEJMsa1212779; Brett O’Hara and Matthew W. Brault, “The Disparate Impact of the ACA-Dependent Expansion across Population Subgroups,” Health Services Research 48:5 (October 2013), pp. 1581-92, DOI: 10.1111/1475-6773.12067.
4 Robin A. Cohen and Michael E. Martinez, Health insurance coverage: Early release of estimates from the National Health Interview Survey, January–March 2014. National Center for Health Statistics. September 2014; (http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201406.pdf, accessed October 27, 2014); Jessica C. Smith and Carla Medalia, U.S. Census Bureau, Current Population Reports, P60-250, Health Insurance Coverage in the United States: 2013, U.S. Government Printing Office, Washington, DC, 2014 (http://www.census.gov/content/dam/Census/library/publications/2014/demo/p60-250.pdf, accessed October 27, 2014).