Update (9/22/2017) Latest Census Report: Uninsured Rate at All-Time Low of 8.8 Percent
Healthcare reform has been a hot-button issue over the last seven years, ever since former President Obama signed into law the Affordable Care Act (ACA or Obamacare). With the election of President Trump and a Republican-dominated Congress, it seemed likely that Americans would once again go through another transition, this time into a conservative vision of healthcare reform. Amid political maneuvering and ongoing back-and-forth from both sides of the political aisle, the ACA remains the law of the land – at least for now.
But according to the U.S. Census Bureau, Obamacare appears to be accomplishing at least one of its aims: to reduce the number of people without health insurance. A recent report puts the total number of uninsured Americans at just under 9 percent, the lowest it’s ever been.
Decline Due to Medicaid Expansion and Cost Assistance
By 2009, the uninsured rate in America stood at around 17 percent or just over 51 million people. That number had grown fairly steadily over two decades, with about 30 million people lacking health insurance in 1987. When Obamacare took effect in 2013, opening up the marketplaces for individual (non-group) coverage and allotting subsidies to low- and middle-income families to purchase policies, the uninsured rate started to decline.
Medicaid was also expanded in most states, which attracted larger numbers of low-income Americans who couldn’t afford coverage of any kind. Cost assistance and Medicaid expansion encouraged millions to sign up, resulting in a sharp drop in the uninsured rated between 2014 and now.
In 2016, 28.1 million people lacked health insurance for the whole year, representing a 0.3 percent decline over the previous year (29 million). Despite political turmoil over healthcare reform, the uninsured rate continues to decline.
Gallup Numbers: A Slightly Different Story
It should be noted that recent Gallup polls suggest a higher uninsured rate than the Census Bureau reports. According to Gallup in July, the uninsured rate is rising slightly, standing at about 11.7 percent nationwide. Their survey is based on a quarterly review of health insurance.
Between the first and second quarters of 2017, the uninsured rate rose from 11.3 to 11.7 percent. Gallup did note that the uninsured rate had hit an all-time low of 10.9 percent in the third and fourth quarters of 2016, which is more in line with the Census Bureau’s figures for last year.
Gallup’s figures are based on interviews conducted with a sampling of adults between April and June of 2017. Interestingly, the group that’s been most affected by rising health insurance premiums – a key factor in the increase of uninsured adults – is the group that’s most critical to the success of Obamacare marketplaces.
Adults aged 18 to 34 tend to drop their coverage more frequently than older adults, undoubtedly weighing the cost of continuing coverage against the relatively low cost of the penalty fee for not having health insurance. According to Gallup:
- The uninsured rate for adults aged 18 to 25 increased nearly 2 percentage points between the last quarter of 2016 and the second quarter of 2017;
- The uninsured rate for adults aged 26 to 34 increased about 1.5 percentage points between the last quarter of 2016 and the second quarter of 2017;
- The uninsured rate for adults aged 35 to 64 increased less than 1 percentage point between the last quarter of 2016 and the second quarter of 2017; and
- The uninsured rate for adults over age 65 has remained steady during the same period.
Older adults are much more likely to keep their coverage, probably because they can and do enroll in Medicare. The Gallup survey also reveals that underserved populations, particularly blacks, Hispanics and the poor, have experienced sharp declines in the overall uninsured rate. In the last quarter of 2013, the uninsured rate among Hispanics was nearly 39 percent. That number has since dropped to just over 28 percent, representing a 10 percent decline over the last three years.
In terms of income, lower-income families have also seen a significant decline. At the end of 2013, households earning less than $36,000 a year had an uninsured rate of nearly 31 percent. By the second quarter of 2017, that rate had dropped to just over 21 percent.
Gallup also notes that the source of health insurance has changed somewhat since the final quarter of 2013. In that time, the percentage of people paying for their own healthcare coverage (private, non-group, non-government plans) rose by about 3 percent. Employment-based coverage has remained largely the same, as has Medicare. The number of people getting coverage through Medicaid has increased by 2.3 percent.
GCHJ Proposal – What Does It Mean for Enrollment?
A new Republican-backed bill to repeal and replace the Affordable Care Act is being rushed through Congress this month. Lawmakers are hoping to meet a September 30 deadline to pass the bill using budget reconciliation rules, though its chances seem slim at this point. Dubbed the “GCHJ” bill in honor of its drafters – Lindsey Graham (SC), Bill Cassidy (LA), Dean Heller (NV) and Ron Johnson (WI) – the proposal would eliminate key aspects of Obamacare, such as the individual mandate, and replace ACA funding with block grants based on complex formulas related to a state’s poor population.
Such a measure would undoubtedly have a short- and long-term impact on the uninsured rate nationwide, but to what extent that might be remains to be seen. The Congressional Budget Office will be unable to calculate the impact of enrollment given the short time frame.
(7/10/2015) Gallup Results: show a continued massive drop in the number of uninsured Americans.
ORIGINAL ARTICLE (5/12/2015): According to a Gallup poll conducted between Jan. 2 and March 31 of this year, the number of uninsured adults in the U.S dropped to 11.9 percent in the first quarter of 2015. This represents a 1-point drop since the final quarter of 2014 and an overall decline of 2.7 percent since Gallup first started tracking the uninsured rate back in 2008.
While 2.7 percentage points may not seem significant, it’s important to note the upward trend in the number of uninsured Americans in the period spanning from 2008 to present. During that time, the rate of people living without insurance climbed steadily to a peak of 18 percent at the end of 2013. Since fall 2013, which is when the ACA marketplaces opened for the first time, the rate has decreased drastically. Now, less than 12 percent of the American adult population remains uninsured.
A Targeted Audience
The ACA was designed to grant access to health insurance to all Americans, but the law’s creators have been specifically targeting certain demographics in recent advertisement efforts nationwide. Those include Hispanics, black Americans, low-income families and young people. These demographics represent people who are more likely to lack coverage. Traditionally and today, the Hispanic population in particular is less likely to sign up for health insurance.
In 2013, nearly 39 percent of Hispanics lacked insurance. As of the end of the first quarter in 2015, about 30 percent remain uninsured. The decline by more than 8 points suggests that the government’s advertising efforts are paying off in some ways, but there is still a long way to go in making sure that underrepresented populations get the health insurance that they need.
The demographic that has most benefited from the new healthcare law seems to be the population that the ACA was designed to serve. Low-income families have long been denied access to healthcare simply due to cost. Affordable private plans on the marketplaces and the expansion of Medicaid have helped reduce the number of uninsured poor. According to the Gallup survey, the number of uninsured families that earn less than $36,000 annually dropped from 30.7 percent in 2013 to just 22 percent this spring.
The Impact of Medicaid Expansion
Federal and state marketplaces helped millions of individuals and families throughout the country sign up for health insurance for the first time, but the newly created exchanges can’t take all of the credit for insuring America. Medicaid has played a huge role in helping families gain coverage. Under the ACA, Medicaid was expanded to cover people who earn up to 138 percent of the federal poverty limit. The Supreme Court ruled in 2012 that states could opt out of expansion. While 29 states and the District of Columbia have chosen to expand their Medicaid programs, the remaining states have yet to decide or have chosen to maintain their existing programs.
In states that did expand Medicaid, it’s estimated that about 6.5 million people have gained insurance over the past two years thanks to the new guidelines. The Gallup survey revealed that Medicaid participation is up 2.1 percent since the end of 2013. Medicaid accounts for 9 percent of the insured population among adults aged 18 to 64.
Challenges to the Uninsured Rate
Despite promising numbers in the recent Gallup poll, the government still has work to do in making sure that the ACA works effectively for the long term. The Supreme Court will decide the fate of federal tax subsidies in June based on a case being brought against the language of the law. In this case, plaintiffs argue that residents in states without a state-run health exchange should not be eligible for tax credits to help pay for premiums on the marketplace. If the court rules in their favor, then millions of Americans would lose access to affordable health insurance.
Another challenge centers on Medicaid expansion in states that have opted to keep existing programs in place. Montana recently created an alternative solution to allow Medicaid expansion under certain conditions, but it remains to be seen whether the federal government will agree to their stipulations based on the terms of the ACA.
The Gallup survey looks at numbers through the end of the first quarter, but there may be another drop in the uninsured rate due to the extended sign-up period enacted by the government during tax season. Gallup notes that a recovering economy and job growth may have contributed to the increased number of insured Americans since 2008. The ACA has had its fair share of challenges over the past five years, but the uninsured rate continues to drop despite setbacks and legal challenges.