#LiveAtUrban: Taking Stock of the Affordable Care Act
Open enrollment under the Affordable Care Act (ACA) will soon begin for 2015, and a year after the launch of the Health Insurance Marketplace, many people are wondering how well the system is working. Since 2013, the Urban Institute’s Health Policy Center has been collecting data through the Health Reform Monitoring Survey (HRMS) to learn about the effects of the new health care law. Recently, a panel was assembled for a discussion called “Taking Stock of the Affordable Care Act: What Are the Data Telling Us,” which examined data from three reports based on the HRMS about changes in health insurance coverage, characteristics of people who remain uninsured and consumer experiences with the marketplace.
Katherine Hempstead is the director of the Robert Wood Johnson Foundation, where she works toward achieving the foundation’s objective of having 95 percent of all Americans covered by health insurance by 2020.
Stephen Zuckerman is a senior fellow at the Urban Institute’s Health Policy Center. He is an expert on Medicare and Medicaid policies, including hospital and physician payment and the health care safety net.
Alan Weil, the editor of Health Affairs, moderated the panel. Previously, Weil was the executive director of the National Academy for State Health Policy.
Health insurance coverage
- Data indicate there have been strong gains in insurance coverage since September 2013, with the strongest gains occurring in the states that expanded Medicaid. The number of uninsured adults dropped nearly three times more in the states that expanded Medicaid compared with those that did not.
- Additionally, the increase in insurance coverage was greatest for the lower income populations targeted by the Medicaid expansion, as well as the middle-income segment targeted by the marketplace subsidies.
- However, Long noted, “We are not done. Uninsurance remains quite high for non-elderly adults.” According to HRMS data, 13.9 percent of the U.S. population is uninsured.
Who is still uninsured?
- Hempstead explained that adults who were still uninsured were “more likely to be Spanish speaking, have lower educational attainment and are more likely to be unmarried. So while Sharon did point out that we saw gains in coverage among all groups, it’s still the case that not all groups gained equally.”
- An increasing proportion of uninsured individuals are now living in states that did not expand Medicaid. In September 2013 the uninsured population was divided fairly evenly between states that did expand Medicaid versus those that did not, whereas in June 2014 approximately 60 percent of the uninsured were living in states without expanded Medicaid.
- Almost 60 percent of uninsured adults indicate a financial reason (high cost, can’t afford coverage) for their uninsured status. Hempstead notes that this may suggest an opportunity to provide more information about subsidies that could mitigate these financial concerns.
Experiences with the marketplace
- About 16 percent of adults who were uninsured at the time of the survey had not heard of the Health Insurance Marketplace mandated by the ACA. Among the uninsured adults who had heard of the marketplace, only 30 percent looked for information on the marketplace compared with nearly 60 percent who were insured. Over 50 percent of those who remained uninsured had not looked for information on the marketplace at all, even though they knew of it.
- Those who remained uninsured were more likely to report only using the marketplace website to look for information on marketplace health insurance plans, while the largest proportion of adults who were insured reported they did not use the website directly. According to Zuckerman, this points to the importance of having a system of support for brokers, navigators and application assistors for the next enrollment cycle.
All the panelists indicated that ongoing and targeted education efforts aimed at the subgroups experiencing a slower uptake of health insurance access and coverage would be important moving forward. Hempstead explained this is a “diffusion of a new idea and cultural change” that will take time to spread. Public health professionals, such as MPH@GW graduates, can play a key role in facilitating the dissemination of information about the new health insurance system by helping communicate the importance of health insurance for long-term health and well-being. Zuckerman said, “If we’re committed to insuring larger and larger numbers of people each year, we’re going to have to figure out new strategies each year to get to those people.”
About Amanda Mabry: Amanda Mabry received her Master of Public Health from the George Washington University with a focus in public health communication and marketing. She is currently a second-year doctoral student in the Department of Advertising and Public Relations at the University of Texas at Austin. Her research interests lie in mass media, cultural norms and how social marketing can help improve public health — particularly in the prevention of interpersonal violence.