Commonwealth Fund Report on the Impacts of the ACA in Reducing the Nation’s Uninsured
The Commonwealth Fund has recently published its report on the impacts of the ACA on reducing the numbers of uninsured. The ACA increased coverage for the poor, the moderate income, the young, for whites, blacks and Latinos and for those working for small employers.
The uninsured rates for the poor fell from 35% to 24%; the uninsured rates for young adults fell from 28% to 18% and for adults working for small employers from 32% to 24%. The uninsured rates for the moderate income fell from about 33% to about 16%. Whites benefitted disproportionately from the ACA --falling from 50% of the uninsured before the ACA to less than 40% of the remaining uninsured post ACA.
About 20 million of the uninsured now have coverage and about 24 million remain uninsured. About 1/3rd of the remaining uninsured are poor who live in the 19 states (primarily in the South) that have not yet expanded their Medicaid programs. Among young uninsured adults, 40% would be eligible but for the decisions of 19 states not to expand their Medicaid programs. In states that expanded Medicaid, their percent of uninsured poor fell by nearly 50% (from over 30% to about 16%). In states that did not expand Medicaid, their uninsured rates for the poor fell from 40% to 35%.
About 15% of the remaining uninsured are undocumented who are not Medicaid eligible. The ACA excludes them from the Exchanges and from full scope Medicaid due to their immigration status.
The remaining uninsured, who are Exchange eligible, suffer from two barriers: affordability and lack of information. Only 62% of those remaining uninsured who are Exchange eligible are aware that the Exchanges exist. Among those who never visited the Exchange web sites, 50% believed they would not be eligible and over 60% believed that could not afford the coverage. Among the remaining uninsured, who visited the Exchange web sites and did not purchase coverage but remained uninsured, over 80% believed that they could not afford it.
The region with the largest reduction in their percent of uninsured was the Midwest where the uninsured rates fell from 17% to 8%. The largest reduction in uninsured rates was among Republicans where the uninsured rates fell from 18% to 10% uninsured. Whites fell from 16% uninsured to 9% uninsured; blacks fell from 21% uninsured to 13%, and Latinos from 36% uninsured to 29%.
Conclusions: 1) focus on the states that have not yet expanded Medicaid, 2) improve outreach, education and enrollment assistance to those eligible but not enrolled, 3) increase subsidies to moderate income households and those close to the subsidy limits and 4) adopt immigration reforms permitting a road to status legalization.