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More People Pick Up Health Insurance in Wake of ACA

NJ and other ‘expansion states’ show strongest gains, but current uncertainty about the future of Obamacare has slowed sign-ups in some states

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Health insurance coverage continued to expand nationwide during the third year of the federal Affordable Care Act — albeit at a slower pace — including in New Jersey, where some 66,000 residents were added to the rolls in 2016, according to federal data.

U.S. Census Bureau figures released Tuesday showed that while 27.3 million Americans — or 8.6 percent of the population — remained uninsured as of 2016, that was nearly 2.5 million fewer than went without coverage the previous year. In New Jersey, some 705,000 residents lacked a healthcare policy last year, or about 8 percent of the state’s population; in other states, it ranged from 2.5 percent uninsured in Massachusetts, to 16.6 percent in Texas.

Coverage gains continued in 2016 in communities across America, but the uninsured rates were lower in states like New Jersey that chose to take full advantage of the landmark law. These 31 “Medicaid expansion” states had an average uninsured rate of 6.5 percent in 2016, versus 11.7 percent in the states that did less to embrace the federal law, the census found.

Targeting Obamacare

While the ACA, or Obamacare, which took full effect in 2014 and has enabled tens of millions of Americans to obtain coverage they could not previously afford — including some 800,000 Garden State residents — it has also been a target for reform among those who favor less regulatory restriction and seek to reduce federal spending. In addition to expanding eligibility for Medicaid, the law reformed the commercial insurance market and provided various subsidies to help customers afford these policies.

Attempts to overturn and replace the law have failed so far, but a separate study released this week by The Commonwealth Fund, a private healthcare foundation, suggests concern over the future of the law may already be impacting the positive trend. A survey this spring of nearly 5,000 people nationwide showed uninsured rates are on the rise in 2017 among some groups, including those ages 35-49, middle-class individuals, and people in states that didn’t expand Medicaid.

“Since 2013, uninsured rates in states that expanded Medicaid eligibility have fallen by a much larger margin than the rates in the 19 states that have not expanded the program,” the Commonwealth study notes. “We find a widening of the divide between expansion and non-expansion states,” it continues, noting that in 2017 the uninsured rate in non-expansion states increased by nearly double the rate in states that did embrace the Medicaid expansion.

Other reports suggest insurance policy costs are likely to rise as much as 50 percent next year in some cities and double-digit increases in premiums are anticipated in many states, reducing the affordability of these products.

Rallying to protect ACA

In New Jersey, healthcare analysts, providers, and patient advocates have rallied to protect the ACA, which has significantly expanded public access to healthcare and led to significant growth in the industry. Broader insurance coverage has also allowed the state to save hundreds of millions of dollars annually on charity care, or hospital treatment for uninsured patients that once fell largely to taxpayers.

"More New Jerseyans are getting vital health coverage, thanks mostly to the Affordable Care Act, including the Medicaid expansion,” noted Ray Castro, a healthcare analyst at New Jersey Policy Perspective who has tracked the law’s evolution. “This remarkable progress we've made must not be undone by continued efforts to repeal and replace the Affordable Care Act.”

After one failed attempt, the U.S. House of Representatives passed a controversial reform measure in May, thanks largely to an amendment negotiated by New Jersey Congressman Tom MacArthur (R-3). But the Senate failed to adopt its own ACA reform in July and lawmakers are now debating other options while trying to identify aspects of the issue that could gain bipartisan support.

Downward trend

To assess the impact of the law, the census bureau used data from two surveys; the Current Population Survey was used to determine individuals’ coverage at any point during the entire calendar year and the American Community Survey, a much larger sample, indicated insurance status at the time of the interview. While the two formats yielded slightly different results, both indicated the downward trend in uninsured rates.

According to the ACS findings, 14.5 percent of Americans were uninsured in 2013, before Obamacare’s full impact, and this declined to 11.7 percent in 2014, and 9.4 percent in 2015. New Jersey follows a similar trend, dropping from 13.2 percent of people without coverage in 2013, to 10.9 percent under the first year of the law, and then to 8.7 percent by 2015.

And while New Jersey’s uninsured rate decreased much more slowly in 2016 — falling just 0 .7 percent to 8 percent — Castro noted that the share of Garden State residents who have healthcare coverage has grown nearly 40 percent in three years. Some 1.16 million people lacked insurance before the law took effect, but an NJPP report released earlier this year suggests that number could grow to 1.25 million if the law was repealed. “Our congressional representatives must continue to work to improve the ACA, not dismantle it,” Castro said.

The census surveys also revealed that private, or commercial, insurance remains the most common nationwide, providing coverage for more than two-thirds of Americans with healthcare policies. Some 55.7 percent have plans coordinated by their employer, while 19.4 percent receive Medicaid and 16.7 percent benefit from Medicare.

The federal data also showed that those over 65, or under 19, are most likely to have insurance coverage, as are white, non-Hispanic residents, and those with higher incomes or more education. Some 93.7 percent of white Americans have healthcare policies, while 89.5 percent of black citizens are covered.

In 2016, individuals who earn less than the federal poverty level — or just over $20,000 for a family of three — had the lowest insurance rates, at 83.7 percent, even though they easily qualify for Medicaid. Those earning four times as much had the highest rate of coverage, at 95.6 percent, according to the census.

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