The Affordable Care Act – Who Has It Helped The Most?

CovancePicA new data set has been published that paints a clear picture of who gained insurance coverage during the 2014 open enrollment period, which ended on April 15, 2014.  Recently featured in the New York Times, the data come from Enroll America, a non-profit organization focused on enrolling Americans in health insurance plans, and Civis Analytics, a data analysis firm.

This data set provides insight into the 10 million previously uninsured individuals who now have health insurance.  Overall, these newly-insured people reduced the national uninsured rate for adults under the age of 65 from 16.3% in 2013 to 11.4% in 2014.

In addition, a number of criteria were analyzed, including:

  • Medicaid Expansion
    When the Supreme Court ruled in 2012 that Medicaid expansion was optional, the high court helped determine one of the main criteria for who would benefit from these reforms.  States that expanded their Medicaid programs realized greater reductions in their uninsured rates, dropping from 14.4% to 9.2%, compared to states that did not expand, which dropped from 18.2% to 13.8%.
  • Race
    Though black and Hispanic individuals remain uninsured at higher rates than their white and Asian peers, the former two groups have shown greater reduction in their rates of uninsurance over the past year.  The Hispanic uninsured rate dropped from 26.2% to 16.5%; the black uninsured rate dropped from 24.1% to 16.1%; the white uninsured rate dropped from 14.1% to 10%; and the Asian uninsured rate dropped from 13.6% to 9.7%.
  • Age
    Young adults were identified as a key group for insurers to enroll to prevent premium spikes caused by older and sicker individuals overpopulating the insurance pools; the data indicate that the young adult group witnessed the greatest drop in their uninsured rate.  The 18-34 age group decreased from 21.6% to 14.2%; the 35-44 age group decreased from 16.4% to 11.2%; the 45-54 age group decreased from 15% to 10.5%; and the 55-64 age group decreased from 12.7% to 9.1%.
  • Neighborhood Income
    With certain states raising Medicaid eligibility limits and the federal government providing subsidies for low-income individuals purchasing health insurance through the exchanges, the data show how the law has helped achieve one of its intended goals.  People from low-income neighborhoods witnessed the most significant increase in their insured rates.  The lowest income quintile dropped from 26.4% to 17.5%; the second lowest income quintile dropped from 21.6% to 14.3%; the middle income quintile dropped from 17.5% to 11.9%; the second highest income quintile dropped from 13.4% to 9.4%; and the highest income quintile dropped from 8.2% to 6.5%.
  • Gender
    Even before the Affordable Care Act was implemented, women were more likely to have insurance than men.  This gender gap only increased since the reforms took effect in January 2014, as the uninsurance rate among women dropped from 15.3% to 9.8%, compared to the uninsurance rate among men, which dropped from 17.7% to 13%.
  • County Political Leanings
    Interestingly, areas in the country with Republican leanings saw a greater uptick in insurance rates than those with Democratic leanings.  This may be partly explained by the geographic distribution of wealth in the nation and the fact that many liberal-leaning states (such as Massachusetts) already had initiatives in place to provide access to healthcare for low-income individuals.  This trend is also evidence that traditionally Republican-leaning states that embraced Affordable Care Act reforms (such as Kentucky and Arkansas) were successful in reducing the uninsurance rates in their states.  Overall, the uninsurance rates in counties that traditionally voted Republican dropped from 18.5% to 13.1%, while the rates in in counties that traditionally voted Democrat dropped from 12% to 8.8%.
  • Urban vs. Rural
    Individuals living in rural areas and smaller cities were more likely to gain insurance during the 2014 open enrollment period than individuals living in big cities, who generally were more likely to have health insurance in the first place.  The uninsurance rates for individuals living in rural settings dropped from 20% to 13.3%; the rates for individuals living in small cities dropped from 19% to 12.7%; and the rates for individuals living in larger cities dropped from 16% to 11.1%.

While this data provides a clearer picture of the Affordable Care Act’s impact on the uninsured in 2014, uncertainty remains regarding its impact in the coming year.  The 2015 open enrollment period will present a set of challenges unlike 2014, such as having an enrollment period that is 2 months shorter than 2014, likely less media attention, and a smaller uninsured pool from which to recruit.  Further, certain individuals may decide that purchasing health insurance for another year is not a wise investment due to unexpectedly high out-of-pocket costs and opt not to re-enroll.  Finally, the landscape of Medicaid expansion will likely evolve in the coming year, with a number of states (such as Utah and Indiana) in negotiation with the federal government on terms to expand, while other states could potentially move away from this expansion (namely, Arkansas).  Additionally, there is an increase in the overall amount of insurers participating in the Health Insurance Marketplace, as well as an anticipated decrease in premiums in exchange plans.

Though these variables create uncertainty for the Obama administration and industry stakeholders, the Enroll America/Civis data suggest that those most likely to be enrolled in the 2015 open enrollment period are those individuals who are least likely to have health insurance in the first place. This enrollment period will need to be monitored closely to see if these trends hold true for a second year running.

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