ACA Impact on Uninsured

 VII. Key Issues: Regulation & Reform >> C. Health Reform >> Affordable Care Act (ACA) >> ACA Impact Analysis >> ACA Impact on Access >> Impact on Uninsured (last updated 1.8.23)

Overview

2021 Snapshot

  • The number of Americans without health insurance coverage dropped to a record low of 8% this year, beating the prior low of 9% in 2016, according to a new report from the Department of Health & Human Services (HHS). The uninsured rate declined throughout 2021 and early 2022.
  • About 5.2 million people have gained coverage since 2020, including 4 million adults and 1 million children… More than 35 million Americans are now enrolled in Affordable Care Act coverage, which… includes more than 21 million people who are enrolled in the act’s expansion of Medicaid
  • About 26 million Americans still don’t have health insurance, and about 2% of children are now uninsured, the latest report showed. (WebMD Health News, 8.3.22)

2017 Snapshot

  • Net Gain: 2010 Through Second Quarter 2017. 28.8 million (9.0%) persons of all ages were uninsured at the time of interview—not significantly different from 2016, but 19.8 million fewer persons than in 2010.
  • Children 0-17.
    • NHIS reports an uninsurance rate of  5.0% for the first half of 2017, essentially unchanged from 2016.

2016 Snapshot

  • Net Gain: 2010 Through Third Quarter 2016. As of third quarter 2016, combined Gallup/NHIS data show a maximum of 21.3 million had gained coverage due to ACA (this figure would be 13.2 million lower if a 2008 baseline were used instead of a 2012-2013 time-frame). In contrast, NHIS data show a gain of 18.0 million through the first half of 2016.
    • Children 0-17.
      • NHIS reports an uninsurance rate of 5.0% (corresponding to 3.7 million children) for the first half of 2016, a 23% drop from the rate in 2013 (6.5%, corresponding to 4.8 million children)–a net coverage gain of 1.1 million (Table 1).
    • Adults 18-64.
      • Gallup. Using adjusted Gallup polling data showing the uninsured rate at 11.5% in the first quarter of 2016 compared to an average of 20.3% in a baseline period covering “shortly before 2012 through the third quarter of 2013,” ASPE estimated that as of 2.22.16, 20.0 million non-elderly adults had gained coverage due to ACA. This includes 17.7 million who gained coverage since open enrollment began in October 2013 and 2.3 million young adults who had gained coverage before that date.
        • Note that ASPE adjusts the GallupHealthways WBI data to remove the contribution of general economic conditions (i.e., employment status), overall time trends, geographic location of respondents, and shifting
          demographics to the uninsured rate (p. 3).
        • Thus, ASPE’s adjusted estimate of the uninsured rate was 11.5% in 2016 Q1, versus 11.0% reported by Gallup.
        • Using the same ASPE methodology and a non-elderly adult uninsured rate of 10.9% reported by Gallup for 3rd quarter 2016, the net gain in coverage would be 8.9 percentage points, equivalent to 17.9 million non-elderly adults. To this must be added 2.3 million young adults who gained coverage before October 2013, for a total of 20.2 million.
        • As noted in the 2015 Snapshot below, ASPE is using an artificially high baseline.
      • NHIS. NHIS reports an uninsurance rate of 12.4% (corresponding to 24.5 million non-elderly adults in 2016) for the first half of 2016, a 39% drop from the rate in 2013 (20.4 percent, corresponding to 40.2 million adults in 2016)–a net coverage gain of 15.7 million (Table 1). To this should be added 2.3 million young adults (19-26) who had gained coverage before October 2013.
        • Based on this study, Washington Examiner reported: About 28 million Americans were uninsured during the first six months of the year, or 8.9 percent, unchanged from the first half of 2015.
        • Washington Examiner concluded: “T]he initial gains made under the law have recently slowed, as the marketplaces enter their fourth year of enrollment.”
  • Reduction in Uninsured Risk. The uninsured rate for non-elderly adults (ages 18 to 64) declined by 43% between October 2013 and early 2016 (from 20.3% to 11.5%). The reduction in uninsured risk was higher for Black non-Hispanics (52.7%) than for Hispanics (27%) or White non-Hispanics (50.7%).
  • Gain Attributable to ACA. Adult figures are estimated based on Gallup survey data with appropriate statistical adjustments described in 2015 snapshot below. Figures for children are based on NHIS without similar adjustments.
  • Caveats. The identical caveats apply to 2016 figures as the 2015 figures, as detailed below.
    • That is, if coverage gains had been measured relative to 2008 instead of a 2012-13 baseline, the net gain would have been 13.2 million lower.
    • Also, if ACS is used rather than Gallup, then the net coverage gain would be 0.8 to 2.0 million lower (see 2014 Net Gain).

2015 Snapshot

  • Net Gain: 2010 Through 2015.
    • ASPE Estimate.  ASPE estimated that as of 9.12.15, 17.6 million had gained coverage, including 15.3 million who gained coverage since open enrollment began in October 2013 and 2.3 million young adults who had gained coverage before that date. See Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services. September 2015. Health Insurance Coverage and the Affordable Care Act. While the ACA Exchanges opened in the fall of 2015, those enrolling during this period were securing coverage that did not become effective until 2016. Because there might have been a small amount of attrition in coverage between 9.12.15 and the end of the year, 17.6 million should be viewed as the upper bound on the number who had gained coverage by the end of 2015.
      • Gain Attributable to ACA. Leaving aside the 2.3 million young adults who secured new coverage prior to October 2013, the ASPE estimate is based entirely on analysis of trends observed in quarterly Gallup Surveys (All models use nationally-representative survey weights and adjust for age, sex, race, ethnicity, employment, state of residence, marital status, rural location, and a linear time trend in order to control for changes in the economy, population composition, and non-policy factors affecting health insurance coverage; thus according to CEA director Jason Furman, “the HHS estimate provides the best available guide to the causal effect of the Affordable Care Act on insurance coverage through the third quarter of 2015”).
      • Caveats Concerning ASPE Estimates.
        • Artificially High Baseline. The ASPE figure is based on a baseline period of Q1-2012 through Q3-2013 during which the uninsured rate averaged 20.3%. However, that figure was artificially higher due to the economic slowdown. If a 2008 baseline is used instead–averaging quarterly estimates of 14.6%, 15.0%, 14.4% and 15.4%=14.8%, then the estimated gain in coverage since 2008 would have  been only 4.4 million instead of 17.6 million.
        • Overstated Coverage Gains. Note in Net Gain Through 2014 section below that when compared to ACS figures, the ASPE method may overstate coverage gains by anywhere from 0.8 million (using 2010 base year) to 2.0 million people (using 2008 or 2009 base year).
  • Federal Survey Estimates.
    • ACS. The American Community Survey (ACS), released in September 2016 showed that the average daily number of uninsured declined by 15.4 million between 2013 and 2015 (45.181 million in 2013 vs. 29.758 million in 2015, with the uninsured rate falling from 14.5% to 9.4% during that time) (Table A-1).
    • CPS. The Current Population Survey found a decline of 12.8 million between 2013 and 2015 (41.795 million in 2013 vs. 28.966 million in 2015, with the uninsured rate falling from 13.3% to 9.1%) (Table 1). CPS changed its methodology so that it is not possible to accurately compare figures earlier than 2013.
    • NHIS. Annualized figures from the NHIS show that the uninsured rate fell from 14.4% in 2013 to 9.1% in 2015 (Table 1)–a decline of 16.8 million uninsured when applied to the 2015 population base used for the ACS.
    • Comparison to ASPE.
      • Gain Since 2010.
      • Gain from 2013 through 2015. Compared to the ASPE estimate of 15.3 million who gained coverage since October 2013, the ACS produces nearly an identical figure, the CPS produces a figure that is 16% lower and the NHIS produces a figure that is 10% higher.

2014 Snapshot

  • Net Gain Through 2014. Using the annual ACS figures, the total number of uninsured has declined by 10.7 million between 2008 or 2009 [the reported uninsured rate was identical in both years] and 2014 (or 11.9 million if 2010 is used as the base year) (details here).
    • In contrast, the ASPE method (see 2015 Snapshot above) implies a net gain in coverage through 2014 of 12.7 million since the start of the ACA. 
    • Thus, compared to ACS, the ASPE method overstates gains in coverage by 0.8 to 2.0 million.
  • Disparate Estimates of Coverage Gains from 2013 to 2014. As of mid-July, 2014, there had been a variety of numbers published that purport to describe the net reduction in the number of uninsured since fall 2013 when enrollment on the ACA Exchanges began. These range from 8.0 million (Urban Institute) to 9.5 million (Commonwealth Fund).
    • VOX offers a guide to these various estimates below in How many people have insurance because of Obamacare? 
    • A more critical take on these various surveys is here. An important issue is how much of any observed decline in the number of uninsured can be attributed to the ACA as opposed to an improving economy or a general slow-down in health spending.
  • Federal Survey Estimates. Much more definitive figures came from federal surveys that typically are much larger or more reliable than the private surveys just described because they asked more detailed questions that cross-check whether people really lack coverage.
  • Perspectives on Uninsured Reduction Estimates. ACA critics point out that:

Projections

Congressional Budget Office (CBO)

CBO has continually revised downward its estimates of uninsured coverage under the ACA. The projected reduction in the number of uninsured in 2014 has fallen from 19 million in its earliest (2010) projections to only 13 million in February 2014. These figures compare the number of uninsured without ACA to the number with ACA, taking into account factors such as non-participation by some states in the Medicaid expansion. All figures are calendar year estimates; in projecting insurance coverage, CBO’s estimates are intended to reflect average annual enrollment [footnote b, Table 4]. Thus, it is best to interpret the uninsured figures as an average daily figure, as opposed to a count of individuals who are uninsured all year or ever uninsured (i.e., full- and part-year uninsured). Reports listed in reverse chronological order.

  • Budgetary and Economic Effects of Repealing the Affordable Care Act (6.19.15). CBO projected that repeal of the ACA would result in an increase in the number of uninsured of 29 million in 2016 and 26 million in 2019; the projected number losing Exchange coverage would be 20 million in 2016 and 23 million in 2019; the number losing Medicaid coverage would be 8 million in 2016 and 12 million in 2019; those gaining non-group coverage would be 4 million in both years; and those gaining employer coverage would be 6 million in 2016 and 8 million in 2019 [Table 3].
  • March 2015 Baseline. Insurance Coverage Provisions of the Affordable Care Act. CBO projects a reduction of 17 million uninsured in 2015 (32.7%) and 24 million in 2019 (47.1%). CBO does not explicitly show how the previously uninsured are distributed, but in 2015 projects 11 million new Exchange members, 10 million new Medicaid/CHIP enrollees, 1 million fewer people with employment-based coverage and 3 million fewer people with coverage in the non-group market.
  • January 2015 Baseline. Insurance Coverage Provisions of the Affordable Care Act.  CBO projects a reduction of 19 million uninsured in 2015 (34.5%) and 26 million in 2019 (46.4%).  CBO does not explicitly show how the previously uninsured are distributed, but projects 12 million new Exchange members, 11 million new Medicaid/CHIP enrollees, 2 million fewer people with employment-based coverage and 3 million fewer people with coverage in the non-group market.
  • April 2014 Baseline. Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April 2014.  CBO projects a reduction of 12 million uninsured in 2014 (22.2%) and 26 million in 2019 (46.4%).  CBO does not explicitly show how the previously uninsured are distributed, but projects 6 million new Exchange members, 7 million new Medicaid/CHIP enrollees and 1 million fewer people with coverage in the non-group market. Due to the expense of non-group coverage, most experts assume the latter would obtain Exchange coverage rather than qualify for Medicaid, in which case the Exchanges would be expected to cover a net of 5 million previously uninsured, while Medicaid would cover roughly 7 million and employers would cover under 500,000. All figures are reported to the nearest million, so the figure for the Exchanges could be as high as 5.5 million, while the Medicaid figure could be as low as 6.5 million.
  • February 2014 Baseline. Table 2. Effects of the Affordable Care Act on Health Insurance Coverage (February 2014). CBO projects a reduction of 13 million uninsured in 2014 (22.8%) and 25 million in 2019 (45.5%).  CBO does not explicitly show how the previously uninsured are distributed, but projects 6 million new Exchange members, 8 million new Medicaid/CHIP enrollees and 2 million fewer people with coverage in the non-group market. Due to the expense of non-group coverage, most experts assume the latter would obtain Exchange coverage rather than qualify for Medicaid, in which case the Exchanges would be expected to cover a net of 4 million previously uninsured, while Medicaid would cover roughly 8 million and employers would cover under 500,000. All figures are reported to the nearest million, so the figure for the Exchanges could be as high as 4.5 million, while the Medicaid figure could be as low as 7.5 million.
  • May 2013 Baseline. CBO projected 14 million uninsured would gain coverage in 2014 (a reduction of 25%) and  25 million by 2019 (a reduction 46%) [Table 1]. Absent ACA, CBO projected that the number of uninsured would remain stable at 57 million in 2013 and 2014.
  • February 2013 Baseline. CBO projected 14 million uninsured would gain coverage in 2014 (a reduction of 24.1%) and  27 million by 2019 (a reduction 48.2%) [Table 1]. Absent ACA, CBO projected that the number of uninsured would remain stable at 58 million in 2013 and 2014.
  • July 24, 2012. Following the Supreme Court decision, CBO projected 14 million would gain coverage in 2014 [Table 1]. No figures were reported for 2019 and there is no way to calculate percentage reductions from the figures provided, but assuming the projected number of uninsured was the same as in the March 2012 baseline, this would represent a reduction of 25.0%.
  • March 2012 Baseline. CBO projected 18 million uninsured would gain coverage in 2014 (a reduction of 32.1%) and 31 million by 2019 (a reduction of 54.4%) [Table 3]. Absent ACA, CBO projected that the number of uninsured would rise from 55 million in 2012 to 56 million by 2014.
  • March 2011 Baseline. CBO projected 21 million uninsured would gain coverage in 2014 (a reduction of 38.9%) and 33 million by 2019 (a reduction of 60.0%) [Table 3]. Absent ACA, CBO projected that the number of uninsured would decline from 55 million in 2011 to 54 million by 2014.
  • March 20, 2010.  Just prior to passage of what would become the ACA, CBO estimated that the law would reduce the number of uninsured in 2014 by 19 million (a reduction of 37.3%) and 32 million by 2019 (a reduction of 59.3%) [Table 4] . Absent ACA, CBO projected that the number of uninsured would rise from 50 million in 2010 to 51 million by 2014.

Centers for Medicare and Medicaid Services (CMS)

The Medicare actuary likewise has persistently lowered its projections of the pace at which the ACA would reduce the number of uninsured. CMS uses the following method for estimating the historical number of uninsured: Persons not covered by health insurance ( including individuals using the Indian Health Service in order to be consistent with CPS definitions) are considered uninsured. The number of uninsured for 1987-2009 was estimated using the levels from the enhanced CPS (SHADAC), adjusted for an estimate of the Medicaid undercount, and for 2010 to 2013, estimates were extrapolated using growth from National Health Interview Survey (NHIS). Reports are listed in reverse chronological order.

  • 2015 Estimates. Keehan, Sean P., et al. “National Health Expenditure Projections, 2014-24: Spending Growth Faster Than Recent Trends.” Health affairs (Project Hope) 34 8 (2015): 1407-17. (Table 17). Total uninsured for 2014 shown as 35.7 m., dropping to 27.6 m. in 2015, then to 26.1 m. in 2016, to its lowest point at 25.5 m. (2017 and 2018), then rising to 25.7 m. in 2019, 25.9 m. in 2020, 26.1 m. in 2021, 26.2 m. in 2022 and 26.4 m. in 2023 and 2024.
    • The number on Medicaid/CHIP was shown as 66.5 m. (2014), 70.5 m. (2015), 72.0 m. (2016), 73.8 m. (2017), 74.7 m. (2018), 75.3 m. (2019), 75.9 m. (2020), 76.4 m. (2021), 77.0 m. (2022), 77.5 m. (2023), 78.1  m. (2024).
  • 2013 Estimates.  National Health Expenditure Projections 2012-2022. The projections were based on the National Health Expenditures (NHE) released in January 2013. By 2013, Exchange enrollment was no longer separately reported, but the number on Medicaid was now expected to grow by only 8.7 million between 2013 and 2014, while the number of uninsured was expected to decline by 11.1 million during the same period, from 46.0m. to 34.9m. (Table 17).
  • 2012 Estimates.  National Health Expenditure Projections 2011-2021. These projections were based on the National Health Expenditures (NHE) released in January 2012. By 2012, CMS had dramatically reduced its estimate of the number who would enroll in the ACA Exchanges in their first year (2014), to only 12.3 million, while the increase in the number on Medicaid was projected to go up slightly faster than the 2011 estimate, increasing by 19.6 million between 2013 and 2014.  The number of uninsured was expected to decline by 19.8 million during that same period, from 48.6m. to 27.8m. (Table 17).
  • 2011 Estimates. National Health Expenditure Projections 2010-2020. These projections are based on the National Health Expenditures released in January 2011. These estimates no longer included a non-ACA counterfactual scenario, but projected 13.9 million to enroll in the ACA Exchanges in 2014 and the number on Medicaid to grow by 19.3 million between 2013 and 2014. Between 2013 and 2014, the number of uninsured was expected to decline by 21.4 million, from 49.8m to 28.4m. (Table 17).
  • April 22, 2010. In its first official estimates following passage of ACA, CMS projected that absent the ACA, the number of uninsured would decline from 48.3 million in 2010 to 47.9 million in 2012, rising to 48.1 million in 2013 and to 50 million by 2014.  With ACA, the number of uninsured was projected to decline to 47.5 million in 2010, to 47.4 million in 2012, 47.6 million in 2013 and then plummet by 50% to only 23.8 million in 2014 (Table 2).  CMS expected 16.9 million to enroll in the ACA Exchanges in 2014 and the number on Medicaid to increase by 23 million that year relative to the expected number absent the ACA.

Society of Actuaries (SOA)

Research sponsored by the Society of Actuaries (SOA) Cost of the Newly Insured Under the Affordable Care Act (March 2013) was released in an Excel spreadsheet for every state. These estimates project the impact of ACA in 2014 under the counterfactual assumption that all provisions are fully in force that year (these percentage reductions can reasonably be compared to the CBO figures for 2019). For a baseline scenario assuming all states expand Medicaid uninsured percentage is expected to drop by 59%; under a no Medicaid expansion scenario in which no states expand Medicaid, this decline would be only 43%. For every state, the following table is reported for each scenario as well as a scenario without any Exchange subsidies and 2 alternative methods for calculating impacts:

  • Figure 2- Changes in Sources of Coverage under the ACA for Currently Uninsured in 2014. This focuses exclusively on those who were uninsured at baseline, broken down by Age [Under 19, 19-24, 25-34, 35-44, 45-54, 55 & over]; Poverty Level [Below 138% FPL, 138%-199% FPL, 200%-299% FPL, 300%-399% FPL, 400% FPL and above]; and Self Reported Health Status [Excellent, Good, Fair, Poor] and shows shows transitions to 7 types of coverage in 2014 [Employer Exchange, Individual Exchange, Private Employer, Private Non-Group, Medicare/TRICARE, Medicaid/CHIP, Uninsured]

Other Estimates

  • Parente, Steven and Bianca Frogner. In an unpublished paper from June 2014, Steve Parente (University of Minnesota) and Bianca Frogner (GWU) estimate that by 2024, there will be more than 40 million uninsured, roughly 10% more than today.
    • The authors estimate that Medicaid enrollment will increase by 2%-3% annually through 2024. Yet this will not capture everyone. Many will not be eligible for the program, because either they earn more than 133% of the federal poverty level (currently $11,670 for an individual, $23,850 for a family of four) or their state did not expand Medicaid.
    • They further calculate that there will be a significant number of uninsured Americans unwilling or unable to pay for the inflated insurance available on the exchanges and forced to pay penalties, which for 2016 and thereafter will be the greater of $695 or 2.5% of income. More will choose this option every year.
  • Center for Health and Economy. Health and Economy Baseline Estimates, July 14. 2014. In this analysis, an increase in the number of uninsured begins after 2016 due to the phase out of the risk protections for insurance companies and the discontinuation of non-qualified health plans currently available in the market. These changes are expected to create a slight increase in the uninsured in 2017, and steady year-on-year premium increases that lead to higher uninsured numbers later in the 10-year analysis period, with an estimated 37 million uninsured in 2023.

Current Estimates

Administrative Data

ACA Exchanges. Only a handful of Exchanges are collecting data on how many new enrollees previously lack health insurance. A detailed assessment of how many uninsured may have been covered through the Exchanges to date is at Number Previously Uninsured. Yet even if every state compiled this information, it would not provide insights into off-Exchange enrollments or how many uninsured might elect to take an offer of employer coverage to avoid the individual mandate penalty. Moreover, the CBO projects that roughly two-thirds of the newly covered will rely on Medicaid (see above). Thus, the most reliable means of ascertaining whether the ACA is reducing the number of uninsured will be through survey data.

Medicaid Enrollment. CMS has issued a series of monthly reports on state Medicaid and Children’s Health Insurance Program (CHIP) data, and represents state Medicaid and CHIP agencies’ eligibility activity, but there is a lag in the  data: the April 4, 2014 report covered the calendar month of February 2014. This report includes state data and analysis regarding applications to Medicaid and CHIP agencies and the State Based Marketplaces (SBMs) and eligibility determinations made by the Medicaid and CHIP agencies. The latest month’s reported data are considered preliminary for a variety of reasons, but in any case, the figures do not provide any hard numbers on how many formerly uninsured obtained coverage.

How Many are Newly Insured as a Result of the ACA? Comparison of CBO, Medicaid Actuaries, MACPAC, KFF, and RAND estimates. “The chart below shows the estimates of the number of people that are newly insured as a result of various provisions of the ACA. While the average estimate shows 20.85 million people have benefitted from the ACA, it is important to note that some people currently enrolled in Medicaid could have enrolled in Exchange coverage with nearly full subsidization had their state not expanded Medicaid, and would very likely be eligible for whatever new subsidy structure might replace the current system. Many of those benefitting from the ‘under age 26’ provision likely have offers of insurance of their own that they are currently forgoing because it is easier to have their parents pay their premiums. Regarding those in the Individual Market, not all of these individuals are receiving subsidies and would therefore not be financially impacted by the repeal. Finally, at least a few million people are believed to have lost their employer coverage as a result of the ACA, particularly the cost and complexity of the many new regulations. Ultimately, the number of people likely to be negatively impacted by a repeal of the ACA is certainly less than 20 million. Making reasonable assumptions and accounting for those who lost insurance because of the ACA, and setting aside any assistance that would be provided by ACA replacement policies, the number of people who, on net, are potentially at risk of being negatively impacted is likely closer to 13-14 million.” (American Action Forum, 1.4.17)

Health Insurer Data 

2015

  • 2015 Health Insurance Enrollment: Net Increase of 4.8 Million, Trends Slowing. “During 2015, the growth in both individual-market and employer-group coverage resulted in a net increase in private-market coverage of 2 million individuals.
    • For individual-market policies, enrollment increased by a bit more than 1.12 million individuals.
    • For the employer-group-coverage market, enrollment in fully insured plans declined by 932,000 individuals, while enrollment in self-insured plans increased by 1.86 million individuals. The net effect of those changes was an increase of 926,000 in the number of individuals with employer-sponsored coverage in 2015.
    • Public program enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) increased by almost 2.77 million individuals in 2015. As in 2014, the change in Medicaid enrollment in 2015 differed notably between states that adopted the ACA’s Medicaid expansion and states that did not. States with the ACA’s Medicaid expansion in effect experienced Medicaid enrollment growth of almost 2.13 million people, while in the states without the expansion in effect, Medicaid enrollment grew by 640,000 individuals.

Implementation of the ACA appears to have had three effects on insurance coverage: a substantial increase in individual-market enrollment, an offsetting decline in fully insured employer-group plan enrollment, and a significant increase in Medicaid enrollment in states that adopted the ACA Medicaid expansion. In all three cases, those effects were greatest in 2014 and continued, though at much reduced rates, in 2015. ” (Heritage.org. 10.31.16)

  • Did Obamacare Really Insure 20 Million? “The Department of Health and Human Services claims that 20 million people have gained health coverage since the enactment of Obamacare in 2010 through early 2016… A recent analysis by The Heritage Foundation’s Edmund Haislmaier and Drew Gonshorowski uses the more accurate method, taking actual enrollment data from Medicaid and private insurance companies to assess the impact Obamacare has had on coverage. The researchers found that just over 14 million people gained coverage from the end of 2013 to the end of 2015. Of those 14 million, 11.8 million gained their insurance through Medicaid and 2.2 million through private coverage.
    • Private market growth has been slow: Enrollment in the individual market increased by 5.9 million and the self-insured employer market grew by 3.9 million. However, these increases were largely offset by an enrollment drop of 7.6 million people in fully insured employer group plans. Overall, the net gain in private market coverage was only 2.3 million people.
    • Medicaid enrollment has surged: In states that adopted Obamacare’s Medicaid expansion, enrollment surged by 10.4 million. However, Medicaid enrollment also rose by 1.4 million in states that didn’t expand their Medicaid programs. Overall, enrollment in Medicaid and the Children’s Health Insurance Program accounts for 84 percent of the total coverage gains from Obamacare since 2014. (The Daily Signal, 12.9.16)
  • Did ObamaCare Add 20 Million To The Insurance Rolls? Not Even Close. “While the White House derived its number using survey data, which it then adjusted, Heritage instead went directly to the sources for enrollment data — Medicaid and private insurers — to see what’s really happened. What they found is that the Obama administration has inflated the ObamaCare coverage number by almost 42%. The actual gain in coverage between 2013 and 2015 was 14 million, Heritage found. That’s close to the Census Bureau’s estimate that the number of uninsured declined by 12.8 million over these years. And of that, only 2.2 million gained private coverage, Heritage figures. The other 11.8 million went on Medicaid. (Heritage only has hard data through 2015, but enrollment in the exchanges was basically flat in 2016.)” (Investors’ Business Daily, 12.13.16)

2014

  • 2014 Health Insurance Enrollment: Increase Due Almost Entirely to Medicaid Expansion. “Health insurance enrollment data for 2014 shows that the number of Americans with health insurance increased by 9.25 million during the year. However, the vast majority of the increase was the result of 8.99 million individuals being added to the Medicaid rolls. While enrollment in private individual-market plans increased by almost 4.79 million, most of that gain was offset by a reduction of 4.53 million in the number of people with employment-based group coverage. Thus, the net increase in private health insurance in 2014 was just 260,000 people.” Haislmaier, Edmund F., Gonshorowski, Drew. (Heritage Foundation, 10.15.15)
  • Obamacare’s Enrollment Increase: Mainly Due to Medicaid Expansion. Heritage Foundation’s Drew Gonshorowski and Edmund Haislmaier report on an analysis of the second quarter of 2014 ACA enrollments from health insurers’ quarterly reports with state regulators and other data from the Mark Farrah dataset of annual and quarterly insurer regulatory filings. Over the first half of 2014, they found, private health insurance enrollment increased by a net of 2,465,586 individuals. “That net figure reflects the fact that 61 percent of the gain in individual coverage was offset by a drop in employer group coverage.” Medicaid enrollment grew by 6,072,651 individuals. (Heritage.org, October, 2014).

Survey Estimates

Characteristics of Remaining Uninsured

2018. CBO projects that even if it is fully implemented, the ACA will leave 27 million uninsured in 2018. According to Sara Kliff at Vox.com:

  • 45% of these will be individuals who qualify for coverage on the ACA Exchanges or through work but elect not to sign up.
  • 30% will be undocumented workers, who are not eligible for financial assistance.
  • 20% will be individuals eligible for Medicaid who elect not to sign up.
  • 5% will be low-income residents of states that don’t expand Medicaid, who may not have access to affordable coverage.

Distribution by County and State. New York Times reports (10.30.15) “The remaining uninsured are primarily in the South and the Southwest. They tend to be poor. They tend to live in Republican-leaning states. The rates of people without insurance in the Northeast and the upper Midwest have fallen into the single digits since the Affordable Care Act’s main provisions kicked in. But in many parts of the country, obtaining health insurance is still a problem for many Americans.”

  • U.S. Maps by County. The article includes U.S. showing uninsured rate by county for the years 2013, 2014 and 2015.
  • Methodology. The data used to make this map are unlike any other data about the number and location of the uninsured. They’re based on a complex model that Enroll and Civis undertook using a large survey and tools often used by political campaigns to target likely voters. That strategy allows us to show more detail than is available using more conventional surveys — like these state-level surveys from Gallup — but they also use different assumptions than more conventional polling. The census [American Community Survey], which provides the industry gold standard data on the uninsured and where they live, takes a long time to collect and publish data. Last fall, Enroll’s model showed us insurance rates around the country in 2014. The census published 2014 data with a similar level of specificity only this week.

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