Historic Coverage Gains Under the Affordable Care Act

Even as Republican congressional leaders plan to repeal much of the Affordable Care Act (ACA), our new paper shows that all groups in the nation have made historic gains in health coverage since the ACA’s major coverage expansions took effect in 2014.  Here are the main takeaways: 

• Number of uninsured fell by nearly 13 million by 2015.  Starting on January 1, 2014, the ACA allowed states to expand Medicaid to more low-income adults and created subsidies for low- and moderate-income families to buy private coverage through health insurance marketplaces.  Since then, the uninsured rate fell by 2.9 percentage points in 2014 and another 1.3 percentage points in 2015, Census Bureau data show — by far the two greatest single-year declines on record in data going back to 1987.  Nearly 13 million fewer people were uninsured in 2015 than 2013 (see graph).

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• Both private and public coverage expanded.  The share of Americans with private coverage rose from 64.1 percent in 2013 to 67.2 percent in 2015, as more people enrolled in subsidized marketplace coverage and more young adults got coverage under their parents’ job-based plans due to an ACA provision.  The share of Americans with public coverage rose from 34.6 percent in 2013 to 37.1 percent in 2015, largely due to the ACA’s Medicaid expansion. 
• All demographic groups had coverage gains.  For example, nearly 6 million fewer white non-Hispanics were uninsured in 2015 than in 2013, as were more than 4 million fewer Hispanics, 1.8 million fewer African Americans, and nearly 1 million fewer Asian Americans.  Also, nearly 7.5 million fewer people with less than a college degree were uninsured in 2015 than in 2013, as were 2.3 million fewer people with college degrees.
• So did all states.  The uninsured rate dropped by at least one-fifth in 48 states between 2013 and 2015, and by at least one-third in more than half of the states.  Coverage gains were strongest in states adopting the ACA’s Medicaid expansion.  Some 7.2 percent of the people in the 28 states (including the District of Columbia) that had expanded Medicaid by January 2015 were uninsured that year, compared to 12.3 percent of people in the 23 non-expansion states.  The uninsured rate fell in both groups of states between 2013 and 2015 but fell more in expansion states, widening the gap between the two groups from 4.1 to 5.1 percentage points.

While the Census data used in our report only go through 2015, data from the Center for Disease Control and Prevention’s (CDC) National Health Interview Survey show that the uninsured rate was 8.9 percent for the first half of 2016 — the lowest since the CDC began collecting data in 1997 and more than two-fifths below the peak of 16.0 percent in 2010.

While our report focuses on coverage gains under the ACA, a recent Urban Institute report models the impact of partially repealing the ACA, as under a bill similar to the reconciliation bill that President Obama vetoed in 2016.   It finds that in 2019, the number of uninsured would rise by nearly 30 million (and more than double), relative to current law.  Together, these reports show the ACA’s critical value in reducing the ranks of the uninsured.