ACA Coverage Is Improving Access to Care

The Affordable Care Act was designed to increase the number of people who have health insurance and that is happening. Now that many of the major provisions have been implemented for several months, a new Commonwealth Fund report looks at the impact.

The major finding is that the percentage of people age 19-64 who say they don’t have insurance dropped from 20 percent in late 2013 to only 15 percent now. That means an estimated 9.5 million adults have insurance. That is slightly higher than CBO predictions but basically in line with expectations.

Not surprisingly, the largest drops in uninsured is with lower income Americans, who were the main target of the Medicaid expansion and the exchange subsidies. The uninsured rate for this group making under 138 percent of the federal poverty line dropped from 35 percent to 24 percent. Similarly, for people in the 138-249 percent of FPL, the uninsured rate dropped from 32 percent to 22 percent.

Clearly, giving poor people access to Medicaid decreases the number of uninsured. The uninsured rate dropped noticeably in states that took part in the expansion, but remained high in the Republican-controlled states which refused to take part.

Among people who got new insurance because of aspects of the ACA, 58 percent think they are better off now than they were before.

The report is not all positive news for the law. Many people found the new health insurance exchanges difficult to use.

Among people who went to the new health exchange, 51 percent said it was difficult to compare benefits of different plans, 54 percent thought it was difficult to compare out-of-pocket costs, 60 percent thought it was difficult to find the type of coverage they needed, and 58 percent found it difficult to get a plan they could afford. In addition 38 percent of adults who visited the exchange in December rated the experience poor and 32 percent rated it fair.

The results basically confirm what we have known about the law since its inception. Directly providing people with health insurance or giving the money to help buy coverage will reduce the number of uninsured and make some people better off. The problem is the law does this in a very wasteful, needlessly complex, and difficult for regular people to understand.