From all the press coverage (see PPACA Enrollment Hits 4 Million and Obama Administration: PPACA Enrollment Tops 7M), it’s not quite clear how much health insurance enrollment has changed in the U.S. over the past four months. The enrollment in the health coverage mandated by Patient Protection and Affordable Care Act of 2010 (PPACA) has occurred through both a federal health insurance exchange and an array of state exchanges (see PPACA Created A New U.S. Health & Human Service Map).
To increase the proportion of the U.S. population that is insured, the PPACA includes individual and employer mandates, subsidies for lower income individuals, subsidies for small businesses, expansion of Medicaid, and new state- and federally-run health insurance marketplaces – to name a few. Originally, Congressional Budget Office (CBO) predicted that the insured population would increase by 32 million in 2016 and about 34 million in 2021, leaving only 23 million nonelderly residents uninsured (see CBO’s Analysis of the Major Health Care Legislation Enacted in March 2010). Their breakdown includes:
- 24 million people will purchase their own coverage through insurance exchanges.
- Medicaid and CHIP will have roughly 17 million additional enrollees.
- There will be a net reductions of about 6 million people purchasing individual coverage directly from insurers.
Despite the rocky October, 2013 launch of the Federal web site, most estimates of increased enrollment are coming in around 9.5 million individuals (The Los Angeles Times reported on a RAND Corporation, unpublished report with estimates as of March 24, see Obamacare has led to health coverage for millions more people.) RAND found that 9.5 million previously uninsured individuals have gained health insurance coverage through the PPACA. As part of this estimate:
- 2 million uninsured covered through the Exchanges
- 3 million previously uninsured young adults covered under their parents’ policies
- 4.5 million additional people covered through Medicaid.
Also according to the LA Times cited RAND study, the number of adults without health insurance declined from 20.9% at the end of 2013, to 16.6% as of March 22, 2014. But like other PPACA enrollment estimates, this percentage is different by source. According to Gallup-Healthways Well-Being Index, the percentage of adults without health insurance shrank from 17.1% in the last quarter of 2013, to 15.6% in the first three months of 2014 (see Uninsured Rate Falls To Lowest Since 2008: Gallup).
What’s next? Writing for The Pew Charitable Trusts, author Christine Vestal reports that enrollment numbers could go up as consumers who can prove they attempted to sign up before the March 31 deadline earn a two-week grace period (ending April 15) at all federally-run exchanges – and similar arrangements at state-run exchanges (see Next Steps for States and ACA). But, the number of enrollees could also go down, as people either earn employer-sponsored coverage, or stop paying their premiums (roughly 85% of enrollees have actually paid their premiums).
What we’re working with now, are only estimates. In the months ahead, we’ll gain a clearer picture of how PPACA has changed health insurance coverage and influenced costs.