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Historic Coverage Gains Under Health Reform

Days before a Supreme Court ruling that could undo much of health reform, new estimates from the Centers for Disease Control and Prevention show historic gains in coverage in 2014, when the law’s major coverage expansions took effect.

Some 7.9 million fewer non-elderly adults were uninsured in 2014 than in 2013 and their uninsured rate plummeted from 20.4 percent to 16.3 percent, by far the lowest on record in data back to 1997.  That 4.1 percentage-point decline is more than four times larger than any other single-year decline. 

Coverage gains were particularly strong in states that adopted health reform’s Medicaid expansion for low-income adults, widening the gap between the uninsured rates in the two groups of states to 6.3 percentage points (see chart).  The gap was 4.3 percentage points in 2013, before the Medicaid expansion took effect.

Several other states, including Utah and Alaska, still are considering expanding their Medicaid programs this year, which would lead to further coverage gains.  And, preliminary data from a Gallup survey, as well as Medicaid and health reform marketplace administrative enrollment data, show continued improvements in coverage in 2015.

The King v. Burwell case before the Supreme Court could reverse much of these historic coverage gains, however, if the court strikes down the subsidies now going to 6.4 million people enrolled through federal marketplaces.