Patient in waiting room 837x558

Uninsured numbers drop – Good news for those of us who favor government-facilitated health insurance coverage.

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Researchers led by Benjamin Sommers MD PhD, Assistant Professor of Health Policy and Economics at Harvard’s School of Public Health report the results of their analysis of the Gallop-Healthways WBI (shortened in this post to WBI) surveys in a Special Report in the August 28, 2014 issue of the New England Journal of Medicine. And the news is good for those of us that favor government-facilitated health insurance coverage. It appears that significantly more people are insured as a result of the new health insurance Marketplaces as well as the expansion of Medicaid in the states willing to do so.

How the study was done

Formal federal surveys, such as the US Census Bureau and The National Center for Health Statistics surveys of the impact of the 2013 Open Enrollment (for 2014 coverage), won’t be available until later this year. State survey data will takes even longer with estimates expected in the fall of next year. So, researchers have turned to “rapid-turn-around” data sources such as the Gallop-Healthways WBI (shortened in this post to WBI) surveys. Although this survey has a lower response rate than the government surveys, prior analyses have shown the results of the WBI to have a very high level of correlation.

The researchers used WBI survey data for January 1, 2012 to June 30, 2014. This means that the increases in the number insured people related to extending coverage for young adults on their parents policies to age 26 were already incorporated into the baseline. Also, the survey ample included only people between 18 to 64, so increases related to newly insured children were also not counted; nor were individuals who enrolled in Medicaid related to some early Medicaid expansions during 2010 and 2011.

Because open enrollment via the Marketplaces began in October 2013, the study compares increases in the percentage of insured pre- and post open enrollment.

What the study showed

  • Compared with the baseline trend of about 20-21%, the uninsured rate declined by 5.2 percentage points between September 2013 and April 2014 – a 26% decline
  • When looking at individuals with incomes < 138% of the federal poverty level, there was a statistically significant decline of 6 percentage points (p=0.006) in the states that expanded Medicaid compared to a non-significant decline of 3.1 percentage points in states that refused to do so
  • When directly comparing low-income adults in states with expansion vs. those without, Medicaid expansion was associated with a reduction of 5.1 percentage points (p=0.01)
  • People with incomes between 139% and 400% of federal poverty were eligible for subsidies even in states that didn’t expand Medicaid (although the effort to overturn that has met with mixed results). In the Medicaid expansion states (all blue, by the way), uninsured rates dropped by 9 percentage points and in the non-expansion states (red, no surprise there) rates dropped by 5.5%

 

Percentage of Adults 18-64 without Health Insurance, 1/2012 through 6/2014
From NEJM 8/28/2014 (as fou

Having insurance is only part of the story. This study has a limited ability to tell the rest. The two access to care measures in the survey both showed the changes you might expect with an expansion of insurance coverage:

  • There was a 2.2 percentage point increase in the number of people saying they have a personal doctor (p=0.001)
  • And a 2.7% decrease in the number of adults who said they couldn’t afford medical care

The bottom line

Obamacare is working as it is supposed to – more people have health insurance. And, I suspect as we go through the second open enrollment period beginning this fall, we are likely to see the numbers improve even more as the news leaks out the sky didn’t fall because the government intervened to make insurance affordable.

That doesn’t mean there is not a lot more analysis to do. We need to know if costs can be contained, if quality can be maintained or even improved. We need to know and understand what constitutes “good” narrow networks vs. what narrow networks deny people access to quality care. We need to watch carefully to see what happens to individual out of pocket costs (premiums plus deductibles plus copays and/or co-insurance).

But I would say, after a horrifically rocky start, Open Enrollment Season #1 appears to be a success. But then, I have always been a “glass half full” kind of gal.

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