The Commonwealth FundClick to enlarge image.
A new Commonwealth Fund report provides a good New Year marker on the uninsurance rate as a result of the Affordable Care Act. It also in a way offers a challenge to those in Congress who would repeal and replace it.
By 2015, one year after the ACA went into effect, the percentage of uninsured working age Americans fell in every state and the District of Columbia, particularly among those with low incomes who need health insurance the most, the report showed. Adults in Arkansas, California, Kentucky, Nevada, Oregon, Rhode Island, New Mexico, Washington and West Virginia gained the most, the report said. Kentucky led the nation with a 25-percentage-point drop in its rate of those who lacked health insurance.
The report is significant because it also shows the ACA helped people get the care they needed in 2015 compared with 2013, the year before the law went into effect. Since 2013, adults in 28 states and D.C. were less likely to say that health care costs kept them from seeing a doctor when they needed care, the fund reported. Also, the percentage of people at risk for poor health who did not see a doctor declined in 16 states and D.C.
Even some of the 19 states that hadn’t expanded their Medicaid programs as of January 2015 experienced significant drops in their rates of uninsured residents, according the report, A Long Way in a Short Time: States’ Progress on Health Care Coverage and Access, 2013–2015:
“Uninsured rates in several states that had not expanded, including Florida, Georgia, Louisiana, Montana, North Carolina, South Carolina, and Texas, dropped between seven and nine percentage points between 2013 and 2015, as people gained coverage by enrolling through the ACA marketplaces and by learning they qualified for their state’s existing Medicaid program.”
Sara Collins, a report co-author, says, “We know that health insurance is essential for people to get the care they need. In this time of uncertainty about the ACA, it’s important to keep in mind the financial and health protection health insurance provides for families.” Collins is the Commonwealth Fund’s vice president for coverage and access.
For journalists, one strength of the Commomwealth report is its focus on the affordability of health care in all 50 states and D.C. In 2014 and 2015, for example, the report showed that 18 percent to 19 percent of residents under age 65 in Arkansas, Idaho, Louisiana, Mississippi, Montana, Oklahoma and Tennessee spent a high share of their income on out-of-pocket costs for health care. For comparison, those living in Connecticut, Delaware, D.C., Maryland, Massachusetts, Minnesota, New York, Rhode Island and Vermont fared much better. Only 10 percent to 11 percent of residents under age 65 in these states had high out-of-pocket spending, the report said.
In a story last month for Health News Florida, Carol Gentry noted that “Florida saw an ‘impressive’ drop in the rate of uninsured adults in 2014 and 2015.” She said the Commonwealth Fund’s report showed that the national rate of uninsured Americans under age 65 fell from 17 percent in 2013 to 11 percent in 2015. She added this important distinction: that the rate of uninsured Americans, including those 65 and older was at 8.6 percent in March 2016, according to the most recent report (September 2016) from the National Center for Health Statistics, which is part of the federal Centers for Disease Control and Prevention.
The CDC’s report is based on interviews. “In the first three months of 2016, 27.3 million (8.6 percent) persons of all ages were uninsured at the time of interview — 1.3 million fewer persons than in 2015 and 21.3 million fewer persons than in 2010,” the report said. Sarah Kliff at Vox wrote that the 86 percent is the lowest rate the government has ever recorded.
Some reporters, including Stacey Burling of The Philadelphia Inquirer noted that, if the ACA is repealed, some 20 million Americans could lose their health insurance coverage, according to a Commonwealth Fund analysis published in September.
My fellow AHCJ core topic leader, Joanne Kenen, has written about what many Trump supporters believe about the promised elimination of the ACA, how a rollback likely to imperil Medicaid expansion and word that Donald Trump’s nominee to lead HHS once wrote a conservative ACA replacement plan. Also, member Howard Gleckman has written about what seniors can expect in a Trump administration.