However, separate census data showed that medical out-of-pocket expenses dragged 11.2 million people into poverty in 2015, a potential symptom of the shift of moving employees and individuals into health plans that have higher deductibles, copays and coinsurance rates.
“This (report) is really validating the point that the law is working to expand health insurance coverage,” said Erin Trish, a health policy professor at the University of Southern California. But, she said, “There's definitely evidence suggesting people are still having a hard time making their payments for the premiums and out-of-pocket expenses.”
Tuesday's census data mirror what the Centers for Disease Control and Prevention measured in its National Health Interview Survey from earlier this year. In addition, as more people gained health insurance last year, the amount of take-home pay increased. Median household income in 2015 was $56,516, up 5.2% from 2014 and the first annual increase to household pay since 2007.
Some of the starkest differences in health insurance coverage appear in states that expanded Medicaid eligibility versus those that didn't. Texas, Florida and other Republican-led states that have shunned the Medicaid expansion continue to have higher rates of uninsured compared with states that have accepted the federal funding.
“We do see that there's a greater change in expansion states overall than non-expansion states,” Jennifer Cheeseman Day, a Census Bureau analyst, said during a press call Tuesday.
Job-based health coverage remains prevalent. Approximately 55.7% of people had an employer-based plan in 2015, unchanged from over the past few years, showing that most employers have not dumped their workers onto the public exchanges as was originally believed.
“If you go back to any Republican critic of the Affordable Care Act, you're going to find them talking about two things,” Levy said. “One, how it's going to destroy jobs and two, how it's going to destroy employer-based insurance. And there's zero evidence of those things.”
However, more employers now offer high-deductible plans, partly due to the law's looming Cadillac tax. Many of the plans sold on the exchanges also have high deductibles, often exceeding $5,000 for individuals and $10,000 for families. Those plans have forced more people to shoulder more of their healthcare costs out of pocket.
“We've seen the trend over the last decade of increasing the out-of-pocket burden on insured people,” Trish said. “This was going on in the employer-sponsored market even before the ACA came around.” The law, however, mandated maximum annual limits to what people could spend on out of pocket on healthcare.
The uninsured rate mostly hits working-age adults and declines as people get older and move into Medicare. No age group has a higher uninsured rate than people between the ages of 26 and 30, whose rate hovered between 17% and almost 20% in 2015. Under the ACA, parents can keep their children on their health insurance until age 26. Once someone turns 26, he or she has to enroll in coverage through an employer or sign up for a plan on the exchanges.
Many younger, healthier adults have decided to pay the individual mandate penalty, which can be as high as $695 per adult, after they age out of their parents' employer-based plans, and the federal government will aggressively target that age bracket for the upcoming 2017 open enrollment.
After meeting with health insurance executives Monday, President Barack Obama sent a letter to insurers across the county that said the administration will host a Millennial Outreach and Engagement Summit at the White House Sept. 27 that will be “focused exclusively on how to enroll more youth in the marketplace during open enrollment.” Several insurers have scaled back their participation on the exchanges because of financial losses tied to older, sicker and costlier enrollees.
Approximately 28% of exchange enrollees were between the ages of 18 and 34 this year, the key “young invincible” demographic. That rate was essentially unchanged from when the exchanges launched in 2014. Experts believe the exchanges need more of the younger crowd to buy plans and subsidize the care of those who have more healthcare needs.
“You want to have everybody in the pool in order to have the premiums to be stable and reasonable,” Levy said.
