ACA Enrolled 5.4 Million Newly Insured, Report Projects

Mark Crane

April 03, 2014

Over 5 million uninsured US adults signed up for health insurance since September 2013 under the Affordable Care Act (ACA) and overall enrollment will double over the next 2 years, according to new reports from the Urban Institute and the Robert Wood Johnson Foundation (RWJF).

The percentage of uninsured Americans fell from 17.9% in September 2013 to 15.2% at the beginning of March, according to the Health Reform Monitory Survey, a nationally representative quarterly survey of about 7500 adults aged under age 65 years conducted by researchers at the Urban Institute and funded in part by RWJF.

"This represents a major step forward for 5.4 million previously uninsured people who now have health coverage," said Risa Lavizzo-Mourey, MD, president and CEO of RWJF, in a statement. "There is a great deal more work to be done in this area, but today's news provides hope and encouragement to all of us who seek to build a culture of health in America by expanding access to coverage."

The survey suggests that the drop in uninsured numbers occurred in 2014 as enrollment in the health insurance exchanges picked up. The survey shows that 17.5% of Americans were still uninsured in December 2013. That may underestimate the number of people who gained coverage. About 80% of the survey was completed before the enrollment surge in late March, according to an RWJF statement.

As of March 1, the ACA's health insurance marketplaces had enrolled 61% of the projected 2014 enrollment, according to another report, also authored by researchers at the Urban Institute that measures marketplace enrollment against expectations for March 2014 and 2016 using the institute's Health Insurance Policy Simulation Model.

The authors found that as of March 1, the date on which the most recent state-specific estimates were released, the marketplace enrollment figures were about 25% of what is expected by 2016 — approximately 17 million.

"Even with marketplace enrollment surpassing the original goalpost of 7 million, this is still just the beginning. Enrollment is expected to more than double over the next 2 years," Katherine Hempstead, who leads coverage issues at RWJF, said in a statement. "Both state and federal marketplaces are likely to make significant leaps in enrollment as the public becomes more knowledgeable about the new options for coverage that are available to many Americans for the first time."

Significant coverage gains can be expected among enrollees who are eligible for subsidies, as well as those who are not — including individuals who enroll later in 2014 due to qualifying events such as the birth of a child or change in marital status, the report said.

State-run exchanges have been far more successful enrolling people in plans than federally facilitated marketplaces. The state exchanges "have been more supportive of health reform overall and took the trouble to set up their own exchanges instead of letting the federal government do it," John Holahan, a fellow at the Urban Institute, told Medscape Medical News. "They spent more money on outreach and set up their information technology systems quite early. That's why they've done better, although state exchanges in Maryland and Oregon had horrific problems.

"It's harder to explain why some states using the federal system, such as North Carolina and Michigan, did as well as they did," Holahan said. The report found that 85% of new enrollees are receiving subsidies. "We know that means they are low income but we don't know the age breakout. A lot of people who aren't eligible for subsidies may have bought insurance directly through carriers rather than the exchanges."

The researchers are optimistic about future enrollment. "A lot of people who didn't sign up this year will do so in the future," he said. "There's strong outreach by insurers, hospitals, private groups and the federal government. The Web site will be easier to use."

Dispute Over the Numbers

Joseph R. Antos, PhD a fellow at the American Enterprise Institute, is highly skeptical about the report and the Obama Administration's claims that the enrollment is on target. "We don't know how many of the 7 million previously had insurance or how many actually paid premiums," he told Medscape Medical News.

"Just because you've enrolled doesn't mean you've paid a premium and will pay the second month's premium," he said. "A better test would be to look at the number of people who had any kind of insurance at the end of December 2013. Then how many people have insurance at the end of 2014. That will tell you how many are newly insured.”

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