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Health Coverage Gains May Influence Rhetoric

By Rebecca Adams, CQ Roll Call

August 10, 2015 -- Democrats seized on a new Gallup analysis showing that the number of Americans without medical coverage remains low as evidence that more people are benefiting from the controversial health care law.

Several Democrats re-tweeted the mid-year Gallup Inc. report released Monday, which said about 11.7 percent of people in the United States did not have health coverage in the first half of 2015. That's down sharply from about 18 percent of residents at the start of 2014, when the health care law's major coverage expansions took effect. 

"Political attacks from the Republican right have put millions of people's health care in jeopardy, but, luckily, they have failed in Congress and in the Supreme Court," said House Energy and Commerce top Democrat Frank Pallone Jr., in a statement to CQ Roll Call. "I hope that now, with even greater evidence that the ACA is working and saving lives, my Republican colleagues can move on and accept the transformative and positive impact the law is having on our country." 

Supporters of the law hope that as more people gain coverage, the political fight over health care will fade. President Barack Obama won a legal victory in late June as the Supreme Court ruled federal subsidies for health insurance should be allowed in every state. But Republicans gearing up their 2016 campaigns continue to argue that the law damages the economy.

"Democrats are going to take this as one of the great achievements since Franklin Roosevelt," said Robert Blendon, senior associate dean for policy translation and leadership development at Harvard University. "Every time more people are signed up, they're going to talk about it. As we see a larger share of people covered, the more the Democratic story about the law will have a positive play to their campaigns."

Republican voters, on the other hand, still oppose the law, Blendon said, and GOP candidates will argue that the law is "too costly for middle-income Americans whose incomes aren't growing and it's affecting employment."

The midyear report echoes findings that looked at shorter time periods. Last month, Gallup reported that the number of people without insurance in the second quarter of the year fell to 11.4 percent, its lowest point since Gallup began tracking coverage in early 2008.  Gallup and Healthways ask 500 U.S. adults each day whether they have health insurance.

As of midyear, Rhode Island had the lowest uninsured rate nationwide, with less than 3 percent of residents lacking coverage, Gallup found. States led by critics of the law tend to have higher uninsured rates. In Texas, nearly 21 percent of people aren't covered.

States that helped implement the law saw the biggest increases in coverage. States that both expanded Medicaid, the federal-state program for the low-income, and built their own health insurance enrollment websites made the most progress, the Gallup midyear report found, mirroring similar findings over the past year.

The health law allows states to expand Medicaid for people with income up to 38 percent above the federal poverty level. So far, 30 states and the District of Columbia have expanded Medicaid.

Arkansas, Kentucky, Oregon, Rhode Island, and Washington all saw drops in the uninsured rate of more than 10 percentage points from 2013 to the first half of 2015. In Arkansas, the share of residents without coverage fell from 22.5 percent to 9.1 percent—a 13.4 point decrease.

While seven of the 10 states that saw the biggest improvements in coverage rates broadened Medicaid eligibility and constructed their own health insurance exchange websites, Mississippi did neither. Mississippi's uninsured rate fell from 22.4 percent of residents to 14.2 percent.

Among the 10 states with the largest changes, North Dakota relied on the federal website to enroll its residents but expanded Medicaid. Alaska also used instead of building its own exchange but recently adopted the Medicaid expansion.

The Gallup data precede an upcoming spate of releases about health enrollment statistics. This week, the federal government is likely to release new enrollment data from the new health insurance exchanges created by the health care law. The Centers for Disease Control and Prevention also is expected to release separate data about the percentage of people who had coverage earlier this year.

Supporters of the law hope the drumbeat of news about health coverage gains will give them a chance to restate their argument about the 2010 law's benefits and ultimately will translate into a more positive political narrative.

However, public opinion has inched up only slightly. About 47 percent of Americans approved of the law in a Gallup poll based on 2,013 respondents conducted between July 1 and July 5, right after the Supreme Court decision in King v. Burwell. That's a more positive view than late last year, when 56 percent of people disapproved of the law and 37 percent backed it. But Gallup surveys since early 2013 have never shown that a majority of people support the law.

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