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Is the Affordable Care Act Working?

Is the Affordable Care Act Working?

by Alyssa Davis

About 7.26 million Americans have gotten health insurance coverage since late last year and 4% of Americans became insured for the first time in 2014.

These findings were announced at "An Inside Look at Gallup's Healthcare and ACA Data," an event held today at Gallup's World Headquarters in Washington D.C. Research Director for the Gallup-Healthways Well-Being Index Dan Witters and Gallup's Editor-in-Chief Frank Newport shared new data from the largest and most comprehensive poll to date assessing the impact of the 2010 Affordable Care Act, commonly known as "Obamacare."

While Republican leaders often give low estimates and Democratic leaders give high estimates for how many people have become insured since the ACA was implemented, Gallup surveys at least 500 Americans every night through the Gallup-Healthways Well-Being Index and another 500 through the Gallup Daily tracking survey to track changes in the percentage of uninsured Americans in real time.

Here are some key findings from the event that begin to answer the question of whether the ACA is meeting its objective of insuring more Americans:

  • There has been a statistically significant and meaningfully large decline in the percentage of uninsured U.S. adults. The uninsured rate peaked at 18.0% in the third quarter of 2013, the highest rate measured since Gallup and Healthways began tracking in 2008. The uninsured rate has been consistently trending downward since then, falling to 15.0% in March and further to 12.9% for April 1-14 polling. If the rate for the first half of April holds throughout the month, it will be the lowest monthly uninsured rate in 76 months of tracking.
  • The uninsured rate within all major racial and ethnic groups has declined since late 2013. However, not all groups are benefiting equally. The uninsured rate among Hispanics has dropped 4.4 percentage points to 37%, but this rate is still, by far, the highest across major racial and ethnic subgroups.
  • Uninsured rates are declining faster in some states than in others. As Dan Witters reported on this morning, the uninsured rate in the 21 states (and the District of Columbia) that have chosen to expand Medicaid and set up a locally managed marketplace exchange has dropped three times as much as the rate in states that didn't take these actions. This finding suggests that these mechanisms seem to be working.
  • Half of newly insured Americans got their insurance through an exchange. Gallup asked Americans who said they got a new policy in 2014 whether they had a policy in 2013. Four percent of Americans did not have a policy previously and became insured for the first time this year. Of these Americans, about half (2.1%) say they purchased their plan through a federal or state exchange. The other half of newly insured Americans got insurance through other sources, such as an employer, Medicaid expansion, or private insurance companies.
  • The newly insured skew slightly younger, but not healthier. Young and healthy Americans are an important target in public outreach efforts for enrollment, because they essentially subsidize the cost of insurance for those who are older and less healthy. Frank Newport's analysis of Gallup Daily tracking data shows that newly insured Americans are fairly evenly distributed across 18- to 64-year-olds, with a slight to moderate skew toward younger Americans aged 18 to 29 years. Using a measure of self-reported health status, Gallup found that the newly insured in 2014 mirror the health of the overall population, meaning they are neither sicker nor healthier. Not surprisingly, the newly insured also tend to have lower incomes and are more likely to be Democrats than the general U.S. adult population.

While there has been a significant drop in the uninsured rate that is attributable to the ACA, there are various factors that could affect whether this rate will decline, tick up, or level off in the future.

First, it is likely that at least some newly insured Americans will not pay their premiums and will rejoin the ranks of the uninsured. Second, as fines for not having insurance rise, it may push down the uninsured rate. A recent analysis on suggests that higher fines would encourage more uninsured Americans to get health coverage. Third, if more states choose to expand Medicaid, the overall uninsured rate likely would decline. Finally, if negative attitudes toward the ACA dissipate in the future and positive views replace them, it could translate into more Americans deciding to sign up rather than pay the fine. So far, however, Americans' views of the ACA have not changed much after the April 1 deadline for the official enrollment period.

To follow Gallup's ongoing coverage of the impact of the Affordable Care Act on the uninsured population, sign up for Gallup News alerts.

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