Many Getting Insured Under ACA, But Are Controls for HealthCare.gov Working?

Separate reports on the success of the Affordable Care Act (ACA) released yesterday suggest it is bringing down rates of uninsured across the country, but that may be at the expense of following the law precisely.

A report from pollster Gallup, which has surveyed adults twice a year since before the law took effect in 2013, on state-level rates of uninsured found that Texas is the only state left where more than 20% of adults remains uninsured. In 2013, there were 14 states where 1 in 5 adults lacked insurance.

The poll found that Arkansas and Kentucky have had the sharpest drops in rates of uninsured since 2013; they started out with rates of 22.5% and 20.4%, respectively, and now each have only 9% of adults who still lack insurance. California’s uninsured rate has dropped from 21.6% to 11.8%. All 3 states have expanded Medicaid, and Kentucky and California have set up their own exchanges.

Arkansas has pursued a special waiver known as the “private option,” which has formed a model for Republican-led states to extend coverage to households up to 138% of the federal poverty line.

However, a separate finding released yesterday from CMS’ Office of the Inspector General (OIG) found that internal controls of HealthCare.gov were not completely effective in weeding out consumers who were not eligible for coverage on the exchange or who were not eligible for premium subsidies. The report covered the first open enrollment period in 2014.

The OIG report was consistent with recent findings of from the Government Accountability Office, which found that 11 phony applications successfully got through the system, received coverage for non-existent persons, and were even re-enrolled for 2015 on HealthCare.gov.

In response to the OIG report, CMS said that it had already fixed several issues related to applicant eligibility. “As with any technology project, part of CMS’ continuous effort involves making regular updates to the system to resolve issues that are identified,” Andrew Slavitt, acting director of CMS, said in a written response.

The Gallup poll found that the following states have uninsured rates below 5%: Rhode Island, Massachusetts, Vermont, Minnesota, Iowa, Connecticut, and Hawaii. Before 2013, only Massachusetts, which had pursued ACA-style healthcare reform on its own prior to the law taking effect, had an uninsured rate below 5%.

Other states with notable drops in the rates of uninsured and their current uninsured rates are Oregon (8.8%), Washington (6.4%), West Virginia (8.3%), and North Dakota (6.9%). Mississippi, which did not expand Medicaid, has fallen from 22.4% to 14.2%.