ACA Pushed Uninsured Rate Down to 10% in 2016, Even More So in Medicaid Expansion States

Health insurance coverage gains created by the Affordable Care Act (ACA) caused the number of the uninsured in the United States to fall from 17% in 2013 to 10% in 2016, according to a new analysis from the Urban Institute. The report said the reductions were even more striking in states that expanded Medicaid.

The report, funded by the Robert Wood Johnson Foundation (RWJF), found that the number of people with health insurance coverage rose by 18.5 million during the period.

Medicaid expansion fueled a majority of coverage gains (10.9 million people). The increases were proportionally higher in the 31 states and the District of Columbia that expanded Medicaid coverage. In expansion states, where 12.6 million gained coverage (9.7 million through Medicaid), the uninsured rated was more than halved, dropping from 15.3% to 7%.

There were gains in nonexpansion states, but at a slower rate: the number of uninsured dropped from 19.8% to 13.7%, with an increase of 5.9 million becoming insured.

Are gains in health insurance coverage weakening?

The improvements in health insurance coverage were broadly distributed across all racial and ethnic groups, workers’ industry type, income and education levels, and age groups, and every group studied had lower uninsured rates in 2016 than in 2013. However, the largest coverage gains were for people with incomes below 138% of the federal poverty level. Other groups benefitting during this period were:

• Hispanics
• Young adults, aged 19 to 25
• Adults with a high school education or less
• Adults working in industries that less frequently offer employer-sponsored insurance, such as retail and construction

The study focused on the types of insurance coverage increasing under the ACA—including employer-sponsored coverage, private nongroup coverage, and Medicaid—and how coverage gained varied by individual characteristics and among groups of states.

There is no explanation other than the ACA for these results, the report said.

“Data show the Affordable Care Act dramatically increased access to affordable health insurance coverage for millions of people,” said Mona Shah, program officer at RWJF, in a statement. “Sustaining these gains will require ongoing outreach to affected individuals and governmental support that underscores a commitment to the importance of health insurance coverage.”

The report does not reflect changes to the marketplaces by the Trump administration in 2017 and 2018 and last year’s repeal of the individual mandate to purchase coverage. For instance, the creation of association health plans and short-term limited duration health plans are expected to negatively affect the number of insured.