Commonwealth Fund study finds parallels in uninsured rate decline, other economic gains and ACA implementation

The vast majority of adults who enrolled for health insurance during the first open enrollment period would likely not have held coverage without the Affordable Care Act expansions, finds a new study from the Commonwealth Fund.

The findings come as the incoming Trump administration and a Republican-controlled Congress are seeking to dismantle the ACA, though they have yet to propose a detailed replacement plan.

Using the National Health Interview Survey and the Behavioral Risk Factor Surveillance Survey, Commonwealth determined that enrollment in ACA-related coverage options explained about 76 percent of the 4-percentage-point decline in the uninsured rate during the first open enrollment period.

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Marketplace enrollments reduced the adult uninsured rate by about 1.7 to 2.3 percentage points, with the effects much more pronounced among adults eligible for income-related subsidies. Medicaid expansions in participating states further reduced the uninsured rate by between 0.76 and 1.0 point.

The dip in the ranks of the uninsured roughly correlates with the 4 percent of the U.S. population that gained coverage through the ACA marketplaces or Medicaid during the first enrollment period. About 8 million people, almost all adults, enrolled in ACA marketplace plans: 2.6 million of these consumers signed up through state-based exchanges, while 5.4 million enrolled through HealthCare.gov on the federally facilitated marketplace. An additional 4.8 million people, or 1.5 percent of the population, enrolled in Medicaid plans.

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States that opted to expand Medicaid cut into the uninsured ranks even more. Overall, the NHIS data show that choosing to expand Medicaid lowered the national uninsured rate for nonelderly adults by 1.7 points. The BRFSS data show a larger reduction of 2.3 points.

Commonwealth found that the state of the economy during the first open enrollment period also affected the uninsured rate. The unemployment rate fell and the cost of healthcare moderated about the same time as the ACA marketplaces launched and Medicaid expanded. Also, some consumers or employers may have dropped their private or employer-sponsored health insurance plans in favor of new options available under the ACA.

Twitter: @JELagasse