Analysts See Federal Reports as Important First Look at ACA's Impact on Coverage

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By Sara Hansard

Sept. 16 — Health-care analysts said two federal reports on health insurance coverage released Sept. 16 confirm data collected from private organizations showing a decline in the uninsured rate following implementation of the Affordable Care Act in 2014.

The analysts focused primarily on the National Health Interview Survey (NHIS), released by the Centers for Disease Control and Prevention, which found that in the first three months of 2014, among people ages 18 to 64, the percentage who were uninsured decreased from 20.4 percent in 2013 to 18.4 percent.

The Census Bureau also released a report, “Health Coverage in the United States: 2013,” showing the percentage of people without health insurance coverage for the entire calendar year was 13.4 percent or 42 million people. The Census Bureau changed its reporting method to improve the accuracy of its coverage data beginning in 2013, which will be a baseline for comparing coverage to 2014 when the primary provisions of the ACA were implemented.

“To get the full picture from Census you'll have to wait until next fall,” when 2014 health insurance data will be reported, Gary Claxton, a vice president of Kaiser Family Foundation, told Bloomberg BNA Sept. 16.

`Important First Look' at Federal Data

The CDC numbers provide a “very important first look from the federal statistical system on how coverage is changing following implementation of these major expansions and other provisions of the Affordable Care Act,” Genevieve Kenney, senior fellow and co-director of the Urban Institute's Health Policy Center, told Bloomberg BNA Sept. 16.

“It looks like the uninsured rate is falling in all the places you'd expect it to,” Kenney said. “It's falling for poor and near-poor adults, and for Hispanics and the non-elderly.”

Kenney also said it is important “that they're showing a statistically important drop in the uninsured rate in states that had expanded Medicaid by Oct. 1, 2013. All those patterns are consistent with what we'd expect given who's being targeted by the Medicaid expansion and who's eligible for the new subsidies through the exchanges.” Subsidies for coverage are available in the ACA marketplaces for low- and moderate-income households.

Trend Toward Decline in Uninsured Rates

“It definitely points to a trend toward a decline in uninsured rates,” Sara Collins, vice president of health-care coverage and access at the Commonwealth Fund (CWF), told Bloomberg BNA Sept. 16. The CWF is a research organization based in New York that is supportive of the ACA.

“When you look at these surveys along with the recent national surveys conducted by the Commonwealth Fund, Gallup, RAND and the Urban Institute, it's clear the law is having its intended effect of reducing the number of uninsured,” Collins said.

It is “particularly striking” that the NHIS report showed a decline in the number of young adults lacking insurance, Collins said. The uninsured rate among adults ages 19 to 25 fell from 26.5 percent in 2013 to 20.9 percent in the first three months of 2014, the report said.

In 2010 the uninsured rate for 19-to-25-year-olds was 33.9 percent, Collins said. “They had the highest rates of uninsurance,” she said. “It does show them benefiting over the last four years from the coverage options” available under the ACA, which include allowing them to stay on parents' plans until age 26 and subsidized coverage in the ACA health insurance marketplaces for low- and moderate-income people.

Drop in Uninsured Likely Higher Than Reported

Joseph Antos, a scholar in health-care and retirement policy for the American Enterprise Institute, a free-market-oriented research organization that has been critical of the ACA, told Bloomberg BNA Sept. 16 that the drop in the uninsurance rates is likely higher than what was reported in the surveys. Since the Census Bureau changed its reporting method beginning with 2013, it is impossible to compare the 2013 data with prior years, and the CDC/NHIS survey probably didn't include much of the late surge in enrollment in the marketplaces in late March and early April, he said.

A critic of the ACA says the HHS should be releasing better data to make its case.

The Department of Health and Human Services (the parent agency of the CDC) “could be releasing better information,” if the agency had been able to collect data on enrollees who were previously uninsured, Antos said. The agency had significant technological problems getting the marketplaces into operation at the beginning of open enrollment in October and November 2013, which made it unlikely it could have taken on more data collection, but it might have been able to get assistance from states that were operating their own marketplaces, he said.

With better data legislators might have been persuaded to increase appropriations and Democratic members “want to be able to report the results,” Antos said. The HHS “dropped the ball,” he said.

Robert Laszewski, president of health policy and marketplace consulting firm Health Policy and Strategy Associates LLC, also told Bloomberg BNA Sept. 16 that he believes the reports understate how much the uninsured rate has fallen after implementation of the ACA. Laszewski has been critical of the ACA.

“My sense is the uninsured [population] has come down by 10 [million] to 11 million” people, he said. About 40 million people had been uninsured before the ACA took effect, Laszewski said. “The glass is about a quarter full.”

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To contact the editor responsible for this story: Janey Cohen at