With much uncertainty surrounding the Affordable Care Act (ACA) and its future, the Commonwealth Fund
took a look at the progress in coverage stemming from the implementation of the law. The analysis found that between 2013 and 2016, the uninsured rate for adults dropped in all states and the District of Colombia.
The past year has seen attempts to repeal and replace the ACA, a shortened enrollment period, and most recently a provision to repeal the ACA’s individual mandate. “It is useful to assess the changes in coverage and access that happened across states under the law before this tumultuous year,” wrote the authors.
At the end of 2016, the number of uninsured Americans under the age of 65 declined by approximately 17.8 million, and uninsured rates dropped in every state and the District of Columbia, according to the authors.
The authors used 6 indicators to assess to what extent healthcare access and affordability improved in from 2013 to 2016: uninsured rates for working-age adults and for children, 3 measures of adult’s access to care, and the percentage of individuals under age 65 with high out-of-pocket medical costs relative to their income.
Results showed that in 2016, 47 states saw their uninsured rate drop at least 5% lower than it had been in 2013. Nearly one-fourth of states saw a double-digit improvement—New Mexico’s uninsured rate dropped from 28% to 13% over the period. Of the 13 states, 11 had expanded Medicaid by January 2016. The 2 exceptions were Florida and Louisiana: Florida did not expand Medicaid but enrolled more people in the marketplace than any other state, and Louisiana expanded Medicaid in July 2016.
For those with incomes below 200% of the federal poverty level, the uninsured rate fell from 38% to 23%, accounting for 9.9 million more low-income adults having health coverage. The decreases were the largest in states that expanded Medicaid, with 9 states cutting their uninsured rate by more than 20%. By 2016, the uninsured rate was 15% or less in one-third of states and the District of Colombia; aside from Wisconsin, all the states had expanded Medicaid.
The authors saw greater coverage for children under 19. The uninsured rate for children during the 3-year period dropped from 8% to 5%, and two-thirds of states saw their rates drop by at least 2%.
Another area of improvement was seen in financial barriers to care. From 2013-2016, there was a significant reduction in the number of adults age 18 and older who reported not being able to see a doctor because of cost. The rate dropped from 16% to 13% and decreased by at least 2% in nearly three-fourths of states and the District of Colombia.
“After 3 years of the ACA’s major coverage expansions, the number of uninsured working-age adults and children in the United States had fallen to a record low,” concluded the authors. “This historic decline was accompanied by widespread reductions in cost-related access problems and improvements in access to routine care for at-risk adults, particularly in states that expanded Medicaid.”