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Number of Uninsured Drops by 5.4M in First Months of ACA Enrollment

Number of Uninsured Drops by 5.4M in First Months of ACA Enrollment

April 4, 2014 — About 5.4 million previously uninsured U.S. residents have gained health insurance since the Affordable Care Act's (PL 111-148) federal and state insurance marketplaces were launched in October 2013, according to a study released Thursday by the Urban Institute's Health Policy Center, Modern Healthcare reports (Demko, Modern Healthcare, 4/3).

For the study, researchers used data from the most recent quarterly Health Reform Monitoring Survey, sponsored by the Robert Wood Johnson Foundation and Ford Foundation. The survey polled about 7,500 adults under age 65 (Robert Wood Johnson Foundation release, 4/3).

According to Modern Healthcare, the study provides the "first credible assessment" of the number of uninsured people who have benefited from the array of coverage options in the marketplaces during the first open enrollment period.

Researchers cautioned that 80% of the Health Reform Monitoring Survey was conducted before the first week in March, meaning that the final results might not completely reflect the enrollment surge in the marketplaces since that time.

Additional Study Findings

Researchers also reported a large gap in uninsured rates between states that have expanded Medicaid under the ACA and states that have declined to do so.

They found that 12.4% of adult residents were uninsured in the 26 states that have expanded Medicaid eligibility, compared with 18.1% in the states that have not expanded eligibility (Modern Healthcare, 4/3).

Researchers also found that the states' decisions on Medicaid expansion had an effect on their uninsured rates. The rates dropped by an average of four percentage points since September 2013 in states that expanded Medicaid, compared with a drop of 1.5 percentage points for the nonexpanding states (Urban Institute release, 4/3).

Nationwide, the percentage of uninsured residents declined from 17.9% in September 2013 to 15.2% last month (Ritger, National Journal, 4/3).


Sharon Long -- a health economist at the Urban Institute and coordinator of the Health Reform Monitoring Survey -- said the decline in uninsurance since September 2013 "reveals a very promising start for the ACA's key coverage expansion provisions," adding, "One can expect even more significant changes as the end-of-March surge in enrollments is accounted for" (RWJF release, 4/3).

However, Jonathan Gruber -- an economist and health care expert at the Massachusetts Institute of Technology -- argued that making assessments at this time is shortsighted because there are too little data to assess how the ACA is affecting the insurance landscape as a whole. He added, "This is really a three-year evaluation process," referring to how long it will take for "the law really to phase in" (Modern Healthcare, 4/3).