Urban Institute Says 5.4 Million Adults Gained Insurance between September 2013 and March 2014

A New York Times editorial Thursday morning assesses the success of the ACA.  It focuses on the number of sign-ups for private coverage through the Marketplace, which recently surged past 7 million.  However, the editorial also cites the Medicaid expansion and other parts of the ACA that have “helped millions by reducing drug costs for chronically ill Medicare beneficiaries; allowing young adults to remain on their parents’ policies; and providing preventive care without cost-sharing.”

The editorial provides a mostly positive assessment of the ACA, but it correctly notes that there are many unanswered questions about the law.  New survey results released later in the day by the Urban Institute Health Policy Center shed some light on one of the very important questions:  how is the law affecting the number of people who are uninsured?

The very good news is that the Urban Institute survey data indicate that approximately 5.4 million non-elderly adults gained insurance from September 2013 to the beginning of March 2014.  That represents a drop in the uninsured rate for that demographic group from 17.9% to 15.2% over that 6-month period, which doesn’t include the effect of the enrollment surge in Marketplace coverage in March.  It also doesn’t include an earlier drop in the uninsured resulting from allowing young adults to remain on their parents’ insurance.

The recent decline in the uninsured rate stems from a combination of factors, including the expansion of Medicaid as well as the new Marketplace insurance options.  Thus, it probably shouldn’t come as a big surprise that the new data show that declines in uninsured populations are much greater in states that expanded Medicaid:

“From September to early March, states that expanded Medicaid saw an average decline in uninsured non-elderly adults of 4.0 percentage points. States that did not expand Medicaid saw a drop in uninsured adults of 1.5 percentage points over the same period.”

Not all of the difference between states can be attributed to their choice on the Medicaid expansion question.  As the brief report notes, most of the non-expansion states didn’t set up their own Marketplaces, which meant that they had less access to federal outreach and enrollment assistance funds.

The drop in the uninsured rate shown by the new survey data is smaller than some of the law’s advocates had predicted, but I think the forecasts of a large decline in the uninsured rate were based on the cumulative impact of several years of implementation.  At this stage in implementation, I think a six-month drop of about 5 million adults is a very respectable result, especially after the rocky roll-out of the Marketplace enrollment process.

In the end, I hope the ACA will be judged on the basis of much more than the effect it has on uninsured rates, although that effect is likely to be and should be one of the most important measures of the law’s success.  I think these preliminary results on insurance rates for adults are very encouraging for the law’s proponents and for everyone who wants to see a significant drop in the uninsured rate.

Jon Peacock