The number of uninsured, working-age Americans has decreased by 7 million since full implementation of the Patient Protection and Affordable Care Act, according to survey data released Thursday by the Commonwealth Fund. The number is lower than other recent estimates, which put the total in the 10 million range.
Roughly 29 million adults ages 19 to 64 lacked insurance last year, down from 36 million in 2012, a 19% drop, the fund reported.
The rate of uninsured adults dipped from 19% in 2012, the last time the Commonwealth survey was conducted, to 16% last year.
“Getting millions of Americans good, secure health insurance is an essential step toward improving their health and helping our healthcare system work more efficiently,” said Dr. David Blumenthal, president of the Commonwealth Fund.
The percentage of uninsured adults is the lowest since the first time the biannual survey was conducted in 2001.
The gains were particularly pronounced among young adults and poor households. The percentage of adults ages 19 to 34 lacking insurance has dropped from 27% in 2010, the year the ACA was passed, to 19% last year. For all non-elderly adults with incomes below 200% of the federal poverty threshold, the uninsured rate dropped from 36% in 2010 to 24% last year.
Other recent studies have shown steeper declines in the number of uninsured since the full implementation of the ACA.
An analysis published in the New England Journal of Medicine last year determined that 10.3 million Americans had gained coverage since 2012. Similarly, the Urban Institute found that 10.6 million individuals had become insured since the launch of the exchanges and Medicaid expansion in roughly half the states. And earlier this month, Gallup reported that the uninsured rate had fallen to 12.9%, a more than 4 point drop from a year earlier.
The Commonwealth Fund also found decreases in the number of Americans reporting financial difficulties because of medical bills. Just over a third of adults indicated that they skipped some form of medical treatment last year because of the cost, down from 43% two years earlier. Similarly, 35% of respondents indicated that they'd struggled to pay medical bills last year, down from 41% in 2012.
But the survey also showed that insured adults still often struggle to pay for healthcare services. Nearly a third of survey respondents who were insured throughout the year reported trouble paying medical bills in 2014.
“Excessive cost-sharing in all insurance types could jeopardize improvements in access to care and medical bill problems documented in the survey,” said Sara Collins, vice president for healthcare coverage and access at the Commonwealth Fund.
The survey found coverage discrepancies between states that opted to expand Medicaid coverage to individuals with incomes up to 138% of the federal poverty threshold and those that didn't move forward with expansion. In the 24 states that had opted for expansion by the time the survey started in July, the uninsured rate among individuals with incomes below 100% of the federal poverty level dropped from 30% to 19%. In non-expansion states, the drop was only slightly smaller, with the uninsured rate falling from 45% to 36% among poor households.
The Commonwealth Fund survey included interviews with 6,027 adults between July and December of last year. It had a margin of error of plus or minus 2 percentage points.
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