Increases in Insurance Coverage Rates From ACA Beginning to Reverse

Health insurance coverage gains since the enactment of the Affordable Care Act (ACA) in 2010 are starting to weaken and reverse, according to findings from the Commonwealth Fund ACA Tracking Survey.

According to the report, declines in coverage are likely attributable to 2 factors: a lack of federal legislative actions to adjust specific weaknesses in the ACA and decisions by the current administration that have exacerbated those weaknesses, such as a shorter enrollment period. Recent changes, including the repeal of the individual mandate, which will go into effect in 2019, may lead to further declines in coverage in the following year. States have also pushed to increase the availability of insurance policies that don’t comply with ACA requirements.

The ACA Tracking Survey is a nationally representative telephone survey that compiles data on coverage rates among individuals aged 19 to 64. The latest outreach was conducted from February through March 2018.

Data from the survey show that the uninsured rate among the population is 15.5%, up from 12.7% in 2016. Uninsured rates among people with earnings 250% or more of the federal poverty level (FPL) has fluctuated, from 4.4% in 2016 to 6.2% in 2017 and then to 5.8% in 2018. However, among those earning less than 250% of the FPL, uninsured rates have continuously increased, from 20.9% in 2016 to 25.7% in 2018.

For those aged 35 to 49, rates grew from 11.3% in 2016 to 17.7% in 2018, leading them to surpass those aged 19 to 34 as the highest uninsured age group. Rates also increased for adults aged 50 to 64 by 3.2%. Meanwhile, adults aged 19 to 34 saw a slight drop in the uninsured rate, from 18.1% to 17%.

In states with expansion, there was a slight rise in the uninsured rate, with an increase of 1%. In states that did not expand Medicaid, the rate increased from 16.1% in 2016 to 21.9% in 2018. Geographically, the uninsured rate remains highest in Southern states at 20.7%. Rates are lowest in the Northeast and Midwest at 10.8%.

Five percent of insured adults indicated that they plan to drop insurance because of the individual mandate repeal. Of those surveyed, 60% were aware that the tax bill had included a repeal of the mandate that requires Americans to have health insurance or pay a penalty. Last month, a health tracking poll from Kaiser Family Foundation surveyed those with nongroup health insurance—those who purchased insurance themselves through the ACA market or outside of the ACA market—about the repeal. Nine out of 10 respondents said that they intend to continue buying their own insurance despite the repeal.

The authors of the Commonwealth Fund report provided 3 approaches to potentially increase coverage:

(1) Providing financial support for advertising to improve awareness of coverage options in all states

(2) Improving health plan affordability in the individual market

(3) Ensuring each market has a participating insurer