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Has the percentage of uninsured people been reduced?

The Number of Americans Without Health Insurance Is Down by About 25 Percent

The number of uninsured Americans has fallen by about 25 percent this year, or about eight million to 11 million people.

At least as many people have enrolled in Medicaid, the government health care program for lower-income people, as have signed up for private insurance through the new online marketplaces.

Several million more are expected to sign up in the coming year, but the total number of uninsured is projected to remain around 30 million for years to come.

Whether the uninsured population is further reduced significantly will depend in part on whether more states opt to expand Medicaid. So far, 23 states have declined to do so.

At its most basic level, the Affordable Care Act was intended to reduce the number of Americans without health insurance. Measured against that goal, it has made considerable progress.

A perfect measurement of the numbers of people affected by the law is still difficult, but a series of private sector surveys and a government report reach the same basic estimates: The number of Americans without health insurance has been reduced by about 25 percent this year — or eight million to 11 million people.

Of that total, it appears that more than half of people who are newly insured signed up for Medicaid, especially in the states that opted to broaden eligibility for the program to low-income residents. Most of the rest enrolled in private health plans through the new state insurance marketplaces.

In addition to the recent changes, three million to four million people, mostly young adults, became newly insured through provisions of the law that kicked in before this year.

“There’s no question it’s come down,” Dan Witters said of the uninsured rate. Mr. Witters is the research director of the Gallup-Healthways Well-Being Index, which has been surveying Americans about their health insurance status since 2008.

Five key surveys show that the percentage of uninsured Americans has declined. 21% 20 BEFORE 20 18 18 18 16% 15 AFTER 14 13 RAND Corporation Commonwealth Fund Gallup Urban Institute C.D.C. Key surveys show that the share of uninsured has declined. BEFORE 21% 20 20 18 18 AFTER 16% 15 14 RAND Corporation Commonwealth Fund Urban Institute C.D.C. Note: For C.D.C., the “before” number is for all of 2013 and the “after” number is for the first three months of 2014. For the RAND survey, the “before” number is for September 2013 and the “after” number is for March 2014. For all other surveys, the “before” numbers are for on or near the third quarter of 2013 and the “after” numbers are for the first six months of 2014. Sources: Commonwealth Fund’s Affordable Care Act Tracking Survey; RAND Health Reform Opinion Study; Urban Institute Health Reform Monitoring Survey; Gallup-Healthways Well-Being Index; Centers for Disease Control and Prevention’s National Health Interview Survey

Gallup has recorded a drop in the percentage of American adults without insurance from 18 percent in mid-2013 to 13.4 percent by the end of May. Those results roughly mirror other polls. The Commonwealth Fund, a health research group in New York, has commissioned a quarterly telephone poll that found a five percentage point reduction in uninsured adults under 65. A government survey from the Centers for Disease Control and Prevention covered only the first three months of the year, but its results are also roughly consistent with the other studies for that period.

Whether the reduction is a success or a disappointment depends on one’s perspective. When the health care law passed in 2010, the Congressional Budget Office estimated that by 2017 about 32 million more Americans would get insurance through the law.

Biggest drops were in states that expanded Medicaid. % uninsured, 2014 2013 0% 5 10 15 20 25 Ark. Ky. Del. Wash. Colo. W.Va. Ore. Calif. N.M. Conn. Md. Nev. R.I. Note: Data are for midyear 2013 and midyear 2014. Source: Gallup-Healthways Well-Being Index

Because of policy changes — most notably, the Supreme Court decision that made state Medicaid expansion optional — the budget office’s current estimate is now lower, about 26 million people. The nation appears to be at least a third of the way to that target.

It is still early to say with much certainty who gained coverage. The large government surveys that are generally considered the most reliable on detailed demographic data lag behind the private surveys. But a few trends are clear. Most notably, Medicaid expansion really mattered. States that expanded their programs saw a substantially larger reduction in their uninsured population than states that did not expand.

Asking whether people have insurance is a good first question when it comes to evaluating the law, but it should not be the final one. Critics worry that some people may have signed up and then cycled out of coverage quickly when they failed to pay premiums. Others worry that many of the health plans people bought covered too few doctors or required too high a payment out of pocket to provide meaningful access to coverage.

Over the next four years, the law is projected to expand coverage to millions more Americans. That will be a big change, but it will not eliminate the problem of the uninsured. About 30 million people are expected to remain uninsured even after several years, according to the Congressional Budget Office. Some of that is by design: people in the country illegally, for example, are excluded from coverage under the law.

About four million low-income Americans are caught in a policy gap in those states that have not expanded Medicaid. Some may be difficult to reach — because of mental illness, language barriers or other isolating factors. Others may still find insurance coverage undesirable or unaffordable. The Affordable Care Act will never bring the country universal health insurance coverage, but it is starting to close the gap.