By Melissa Attias, CQ Roll Call
September 16, 2015 -- The share of Americans without insurance fell to 10.4 percent during the first full year of the health care law's coverage expansion in 2014, nearly a 3 percentage point decrease from the previous year, according to a Census report released September 16. The decline represented the biggest year-to-year drop since 2008, when the bureau began tracking such data.
In 2014, 33 million people lacked health coverage for the entire year, compared to 41.8 million people in 2013.
The figures track with other estimates showing a similar decline in the uninsured rate since the implementation of the health law. A Centers for Disease Control and Prevention report released last month found the number of Americans without coverage fell by one-third since 2013, after which the most significant coverage expansions under the law took effect.
The Census Bureau report, based on information from two surveys that use different methodologies, states the drop in the uninsured rate is consistent with the intent of the 2010 overhaul.
Expansions of private and government health coverage were responsible for the growth of the population with coverage, according to the report. The private coverage rate rose by 1.8 percentage points between 2013 and 2014, while the government coverage rate went up by 2 percentage points.
The biggest changes came from the growth of Medicaid and insurance individuals buy directly from an insurer or through new insurance exchanges created by the law. The direct purchase of insurance covered 14.6 percent of the population for all or part of 2014 compared to 11.4 percent in 2013. The portion of people covered by Medicaid, the federal and state program for the low-income, for all or part of 2014 rose to 19.5 percent, up from 17.5 percent in 2013.
Health Law Connection
Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities, said the sizable increases in those two areas are clearly connected to the health law. The overhaul allowed states to expand their Medicaid programs and provided subsidies for some low- and middle-income Americans to buy coverage through the exchanges beginning in 2014. The law also required most individuals to purchase coverage or face penalties.
Park also said the new data showed a widening difference in uninsured rates between states that chose to expand Medicaid and those that have not.
The White House highlighted the issue in a blog post, noting that states that expanded Medicaid saw a 3.4 percentage point drop in their uninsured rate, compared to the 2.3 percentage point reduction in states that did not.
"The causal effect of Medicaid expansion on state uninsured rates is likely even larger since non-expansion states had higher uninsured rates prior to 2014, and states with more uninsured tended to see larger coverage gains during 2014," wrote Council of Economic Advisers Chairman Jason Furman, Council member Sandra Black, and Chief Economist Matt Fiedler.
Heritage Foundation senior research fellow Ed Haislmaier said that government data about the number of people who gained coverage through new marketplace insurance or Medicaid is a better measure of the health care law than the Census statistics.
"What the Census data misses the mark on is that almost all the health insurance enrollment growth in 2014 occurred in Medicaid and there was relatively little net growth in the number of people with private health insurance coverage," Haislmaier said in a statement.
The report also found that every state and the District of Columbia saw a drop in their uninsured rate from 2013 to 2014 while the portion of people without coverage decreased for every age under 65. Although 19- to 64-year-olds had the lowest coverage rate compared to children and older adults, the portion with coverage rose by 4.2 percentage points during that window.