Proponents of the Affordable Care Act have yet another reason to claim victory at the close of the second enrollment period this year. Since the major provisions of Obamacare went into effect in September 2013, nearly 17 million people have gained health insurance according to a longitudinal study funded by the RAND Corporation.
The nonprofit health research organization surveyed the same group of people over a period of 18 months, starting with people who signed up for health insurance during the initial enrollment period in 2013. Tracing those enrollees’ insurance patterns for the next year and a half, the organization found that most people experienced no change at all in health insurance status. Approximately 22.8 million people got health insurance for the first time while 5.9 million lost coverage, which resulted in a net gain of 16.9 million people. Overall, RAND found that the total number of uninsured Americans has decreased from about 43 million people to about 26 million.
Different Sources of Insurance
Not everyone who signed up for health insurance opted to use the newly created federal and state marketplaces. In fact, most people continue to buy health insurance through their employers despite claims by Republican lawmakers that the ACA would result in a net loss of insurance due to stricter employer regulations. The RAND study found that about 9.6 million people gained coverage through work. Employer-sponsored coverage has been the major source of insurance in the United States for decades, and the ACA has not changed that fact. At the outset of the new law, 8.5 million people initially lost coverage due to changes in policy, but just 600,000 remained uninsured once the dust settled. In many cases, work-based insurance has improved drastically thanks to the new law’s regulations.
Coming in at second for the share of the enrolled population is Medicaid, which was newly expanded under the ACA to include people with slightly higher income levels. As it stands, 29 states and the District of Columbia have chosen to expand their Medicaid programs under the provisions of the law. The result is that another 6.5 million people now have health insurance. Currently, four states are considering expanding their programs as well, which may add millions of people to the roster of insured Americans.
The new state and federal marketplaces accounted for a sizable portion of the newly insured population. RAND found that approximately 11.2 million people had signed up for coverage using the exchanges. This number matches the government’s tally this spring. Of the 11.2 million who signed up using a marketplace, about 4.1 million gained insurance for the first time. The remaining 7.1 million came from people who switched over from a different source of insurance. The health insurance marketplaces offer an attractive alternative to many low- and moderate-income families who otherwise may not be able to afford coverage. It’s estimated that about 87 percent of the people who sign up for plans on the marketplaces receive some type of subsidy to offset the cost of premiums.
Good News for ACA Supporters
The RAND researchers point out that their sampling size is relatively small with just 1,589 enrollees. Furthermore, the response rate for the survey was just 9 percent. The limited number of participants and the low response rate may not accurately reflect the total enrollment number in the long run. However, researchers don’t question that insurance options and enrollment have improved thanks to the Affordable Care Act. Longitudinal studies may be more accurate when it comes to recall. In other words, because the same group of respondents has been tracked since the beginning of the study, the responses are more likely to be based on recent memory.
In any case, it seems clear that the ACA is accomplishing its goal of bringing health insurance to those who need it. Not only have more people signed up for coverage under the new law, but people who previously had insurance are looking more closely into their options for affordable plans. As the third open enrollment period begins this fall, more Americans will have better choices on and off the marketplaces.
