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Federal Data Show Uninsured Population Dropping

By Rebecca Adams, CQ HealthBeat Associate Editor

September 16, 2014 -- U.S. government statistics released last week added to growing evidence of a drop in the rate of uninsured people. The data mirrored private polling data by Gallup and others showing that the percentage of Americans who say they are uninsured is falling.

What might have seemed beyond dispute—that the health care law would shrink the U.S. uninsured population—has actually been subject to debate following the late 2013 cancellation by insurers of hundreds of thousands of policies because they didn't comply with the requirements of the overhaul.

The impact on coverage shown by the new statistics is less than dramatic, but the information does not demonstrate the full impact of the law (PL 111-148, PL 111-152) so far.

The government released two sets of data early last week on the insured. One was prepared by the National Center for Health Statistics (NCHS) for the first quarter of 2014, the other by the U.S. Census Bureau for the full year 2013.

The National Center, part of the Centers for Disease Control and Prevention, found that 13.1 percent of Americans, or 41 million people, did not have insurance. That was a drop of about 8 percent, or 3.8 million people, from the previous year.

More people gained benefits with the launch of health insurance marketplaces and the expansion of Medicaid under the overhaul. The NCHS survey of 27,627 people was conducted from January through March, right before a large surge in enrollment in coverage options created by the law.

That late surge may not have been captured in the survey. About 47 percent of the people who enrolled in a marketplace plan did so in March and April, according to the Department of Health and Human Services.

The number of adults below age 65 who were uninsured fell from 20.4 percent in 2013 to 18.4 percent in the survey period. About 3.7 million of the people surveyed between January and March said that they got private insurance through the marketplaces established with federal money under the health care law (PL 111-148, PL 111-152).

HHS announced in April that more than 8 million people bought coverage through the exchanges. Officials said they had no data on how many of them were previously uninsured. The administration also said that about 7.2 million additional people were enrolled in Medicaid and the Children's Health Insurance Program (CHIP) in June. That data, the most recent available, is compared to enrollment in the programs in 2013 right before publicity about the health care law began. Updated Medicaid and CHIP enrollment figures are expected soon.

But despite the millions getting covered in these new ways, the precise effect of the law has been difficult to determine. That's because many policies were cancelled when they did not comply with coverage requirements.

The report provides "more evidence about how the ACA is affecting people a lot," says Larry Levitt, a senior official at the nonpartisan Kaiser Family Foundation. One interesting note, says Levitt: in states that did not expand Medicaid, the change in the uninsured rate was minuscule in the first quarter of the year.

The next version of the NCHS survey will be out in December and will provide "the best available official data on the full effect of the law this year," he added.

In July, the Gallup Organization, which has tracked the rate of uninsured since 2008 in its surveys of about 45,000 people, found that the percentage of uninsured people had fallen from 17.1 percent in the fourth quarter of 2013 to 13.4 percent in the second quarter of 2014, a decline of 3.7 percentage points.

The Centers for Medicare and Medicaid Services Office of the Actuary estimated earlier this month that the number of uninsured Americans is expected to fall from 45 million people in 2012 to 23 million by 2023.

Census Data

Separately, Census Bureau data showed that 13.4 percent or 42 million people lacked coverage throughout 2013.

But it doesn't provide much of a hint about the effect of the law. The insurance people could buy in the new marketplaces did not start until January and the biggest influx of new Medicaid applicants was in 2014. But the census statistics will help researchers gauge the impact of the law in the future.

The bureau in 2013 also changed the way it measures the rate of uninsured, said Census official Victoria Velkoff. As a result, it can't be compared to 2012 data. Velkoff said that the redesign, which was in the works for more than a decade, was planned before the health care law passed.

About 271 million Americans living in the United States had coverage last year. Of those, about 201 million had private health insurance, including 169 million with employer-sponsored coverage and 34 million who bought private coverage on their own.

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