5.4 million fewer uninsured since exchanges opened, survey says

Roughly 5.4 million Americans who previously lacked health insurance have gotten coverage since the state and federal exchanges opened for business on Oct. 1, according to a study conducted by the Urban Institute's Health Policy Research Center.

The uninsured rate for non-elderly adults—those between the ages of 18 and 64—was 15.2 % in March, down 2.7% from September, according to survey results.

The study is believed to be the first credible assessment of how many previously uninsured individuals have gained coverage during the initial open enrollment period. The Obama administration announced this week that 7.1 million individuals signed up for commercial health plans before the March 31 deadline, but has not released any data on how many of those exchange customers were previously uninsured.

The Urban Institute researchers also found a large gap in insurance coverage between states that have opted to expand Medicaid to households with incomes up to 138% of the federal poverty level and those that have refused to implement that piece of the Patient Protection and Affordable Care Act. In the 26 states that have expanded eligibility, 12.4% of adults lacked coverage. That compares with 18.1% in states that have declined to do so.

Jonathan Gruber, an economist and healthcare expert at the Massachusetts Institute of Technology, cautions that many of the states that are moving forward with the Medicaid expansion already had higher rates of coverage, but he still thinks the numbers should put pressure on the other states. “It's a crisis; it's political malpractice,” he said. “The healthcare industry ought to be completely offended that politicians are doing this to their poor citizens.”

There have been other preliminary signs that the rate of uninsured is dropping. Most notably, a Gallup poll released in February found that the level of those lacking coverage had fallen to 16%, down from 17.1% in the fourth quarter of 2013.

The Urban Institute study likely underestimates the number of previously uninsured individuals who have obtained coverage since Oct. 1. That's because 80% of the survey was conducted before the first week of March and therefore likely doesn't fully reflect the enrollment surge leading up to the March 31 deadline.

“I think you can view this as a little bit of a lowball,” said Katherine Hempstead, a senior program officer at the Robert Wood Johnson Foundation, which paid for the study. “If we had been in the field at the end of March, we would have seen a larger decline.”

The Urban Institute began conducting quarterly online surveys to assess the impact of the Affordable Care Act at the start of 2013. There are roughly 7,500 respondents to each questionnaire.

Gruber cautions that any assessment at this point is inherently flawed because there's just not enough data available to judge how the federal healthcare overhaul is changing the insurance landscape. For example, 3.4 million people lost coverage in 2012 because they were no longer employed. Now they will be able to purchase coverage through the exchanges even outside the open enrollment period.

“This is really a three-year evaluation process,” Gruber said. “It's going to take three years for the law really to phase in. People need to just calm the heck down.”

Follow Paul Demko on Twitter: @MHpdemko