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Every Income Group Experienced Significant and Similar Drops in Uninsured Rates Under the Affordable Care Act

HHS just released an analysis showing gains in health insurance coverage from 2010-2015 across key demographic categories of Americans: income, age, geography, race and ethnicity. The report finds that ACA coverage gains and reduction in the uninsured have been widely shared across groups.   Press release link: http://www.hhs.gov/about/news/2016/09/29/every-income-group-experienced-significant-and-similar-drops-uninsured-rates-under-aca.html
ACA led to widespread coverage gains across income, age, geography, and race; expanding Medicaid significantly strengthens gains

Today, the U.S. Department of Health and Human Services released new research analyzing gains in health insurance coverage from 2010-2015 across key demographic categories of Americans: income, age, geography, race and ethnicity. The report finds that ACA coverage gains have been widely shared across groups. For example, the uninsured rate fell by around 40 percent for Americans in all income groups for 2010 through 2015, including individuals with incomes above 400 percent of the federal poverty level (FPL).
“Regardless of your income, age, geography, or race, everyone is gaining access to coverage or better coverage under the Affordable Care Act,” said Secretary Sylvia M. Burwell. “Going into the fourth Open Enrollment, Americans have experienced historic coverage gains. People can’t be discriminated against because of preexisting conditions, young adults can stay on a parent’s plan until age 26, and working families without employer coverage can get help paying for health insurance. People who already had health insurance have benefited from new protections like free preventive services, as well as from slower growth in employer premiums.”
The new report shows how different provisions of the ACA have worked in concert to reduce uninsured rates. The near-equal percent drops in uninsured rates across groups indicate that the ACA is reducing the uninsured rate most in absolute terms among groups that had the highest uninsured rates before the law. For example, individuals age 26-34 and 35-54 saw similar percentage drops in uninsured rates, but since the younger group had higher pre-ACA uninsured rates, a larger fraction of them have gained coverage since its passage. Today’s report looks primarily at data through 2015. In the first quarter of 2016, the national uninsured rate dropped again from 9.1 percent to 8.6 percent.
One of the few groups seeing a notably smaller decline in uninsured rates was Americans living in poverty in states that chose not to expand Medicaid. This group falls into the coverage gap, unable to access Medicaid coverage or Marketplace financial assistance. If the 19 remaining states adopted the ACA’s expansion of Medicaid, an additional 4.1 million residents would gain coverage, according to Urban Institute estimates – PDF.
Income
Gains in health coverage across the income distribution indicate the success of a range of different ACA provisions. While Medicaid expansion has been especially crucial for low-income Americans, moderate- and middle-income families have benefited from consumer protections that prevent insurers from discriminating or denying coverage based on pre-existing conditions, from provisions allowing young adults to stay on their parents’ plans, and from financial assistance that helps families without access to affordable coverage (e.g. employer sponsored insurance).  Overall, all groups have seen percentage reductions in their uninsured rates of around 40 percent.

  • Less than 100% FPL: 39% reduction
  • 100-125% FPL: 48% reduction
  • 125-250% FPL: 41% reduction
  • 250-400% FPL: 37% reduction
  • 400% FPL and higher: 42% reduction

Age
Since 2010, non-elderly adults of all ages have seen substantial decreases in the uninsured rate. But the most dramatic decline has been among 18-25 year olds, who experienced a 52% reduction in the uninsured rate thanks in large part to the ACA provision that allows young adults to remain on their parents’ plan until age 26.

  • 18-25 year olds: 52% reduction
  • 26-34 year olds: 36% reduction
  • 35-54 year olds: 39% reduction
  • 55-64 year olds: 40% reduction

Geography
The uninsured rate has decreased significantly and similarly among in both urban and rural areas since 2010. The similar overall coverage gains for rural individuals are particularly striking in light of the fact that uninsured rural individuals are disproportionately concentrated in states that have not expanded
Medicaid. If all states had expanded Medicaid, rural individuals would likely have seen a larger decline in the uninsured rate.

  • Metropolitan (urban) areas: 42% reduction
  • Non-metropolitan (rural) areas: 39% reduction

Race and Ethnicity
Coverage gains have also been broadly shared across racial and ethnic groups of non-elderly adults.

  • Asian (non-Hispanic): 59% reduction
  • Black (non-Hispanic): 47% reduction
  • White (non-Hispanic): 46% reduction
  • Hispanic: 35% reduction

Medicaid expansion
Medicaid expansion states experienced greater gains in coverage than non-expansion states. Between 2010 and 2015, the overall uninsured rate decreased nearly 50% in expansion states, while declining by nearly 32% in states that chose not to expand.
Consistent with this, improvements in health care coverage among racial and ethnic minority groups in particular have been more dramatic in states that have expanded Medicaid. For example, the uninsured rate among non-elderly Hispanics in expansion states dropped by nearly 43 percent, compared to a 26 percent in non-expansion states.

To find today’s report, visit: https://aspe.hhs.gov/pdf-report/affordable-care-act-has-led-historic-widespread-increase-health-insurance-coverage

To view a chartpack on coverage gains, visit: https://aspe.hhs.gov/pdf-report/chartpack-affordable-care-act-has-led-historic-widespread-increase-health-insurance-coverage

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