Roughly 17 million more Americans have health insurance coverage since the launch of the Affordable Care Act's exchanges and Medicaid expansion, according to a study published Wednesday by RAND Corp. researchers. The number of uninsured, non-elderly adults dropped from 42.7 million in September 2013 to 25.8 million in February 2015.
The RAND study found that 11.2 million Americans enrolled in private health plans through the state and federal marketplaces during the first two open-enrollment periods. That's slightly below the CMS' estimate of 11.7 million sign-ups through the exchanges.
In addition, the RAND researchers estimated that 9.6 million people were newly enrolled in Medicaid since expanded income eligibility became an option for states. The federal government has indicated that 10.8 million people had gained coverage through Medicaid or the Children's Health Insurance Program as of December 2014.
But the coverage gains weren't limited to the main insurance expansion provisions of the Affordable Care Act. Researchers also found that 8 million more Americans were enrolled in employer-sponsored coverage over the time period studied. That suggests that fears that companies would dump coverage and push employees into the exchanges haven't been realized. It also could be that the individual and employer mandates convinced more workers to sign up for coverage and more employers to offer it.
“We don't see any evidence that fewer people have access to insurance through their employer,” said Katherine Carman, an economist with the RAND Corp. and an author of the study, which was published in Health Affairs.
Of those who acquired coverage through the exchanges, 4.1 million—or 37%—reported that they were previously uninsured. Among the population newly enrolled in Medicaid, just over half indicated that they previously lacked coverage.
The RAND study did find that coverage declined in some sectors of the insurance marketplace. For example, the number of Americans enrolled in individual coverage outside of the exchanges dropped by 1.9 million.
But despite widespread media reports and ACA opponents' claims in 2013 and 2014 about people having their health plans cancelled, there's not much evidence that this resulted in people losing coverage. Just 600,000 individuals who reported having individual coverage prior to the launch of the exchanges became uninsured, according to the RAND analysis.
“The media tend to focus on individual stories,” Carman said. “Those are a lot more interesting than statistics.”
The RAND data should be taken with a couple of caveats. It includes 1,589 non-elderly adults who participated in surveys in both September 2013 and February 2015. The response rate was just 9%, which is much lower than for government surveys and could reduce the validity and reliability of the findings.
In addition, there is widespread lack of knowledge about health insurance among consumers. That could lead to confusion about the source of coverage. For instance, individuals who shopped for coverage through the exchange but ultimately ended up in Medicaid might inaccurately report the type of coverage they have.