More Obamacare, less health-cost concerns: study

A new survey suggests that Obamacare has led to declines in the number of people burdened by health-care-related financial problems, as the rate of people who lack health insurance is driven down to new lows.

The Commonwealth Fund, which conducts the survey every two years, said the new report is the first time in about a decade it has ever recorded decreases in the number of people "who reported not getting needed care because of cost," as well as in the number of those "who had problems paying their medical bills or who are paying off medical debt over time."

A marketplace guide works on the Healthcare.gov federal enrollment website as he helps a resident sign up for a health insurance plan under the Affordable Care Act, at an enrollment event in Milford, Del.
Andrew Harrer | Bloomberg | Getty Images
A marketplace guide works on the Healthcare.gov federal enrollment website as he helps a resident sign up for a health insurance plan under the Affordable Care Act, at an enrollment event in Milford, Del.

In 2014, for example, 35 percent of adults, or 64 million people reported some kind of bill problems or medical debt, compared with 41 percent of the population, or 75 million people in 2012, according to the Commonwealth Fund's survey released Thursday.

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Also in 2014, the number of adults who reported not getting needed care because of cost, including visiting a doctor, filling a prescription or getting specialist care had decreased to 66 million, or 36 percent. In 2012, 80 million people, or 43 percent of the population, reported such issues.

"These declines are remarkable and unprecedented in the survey's more than decade-long history," said Sara Collins, the Commonwealth Fund's vice president for health-care coverage and access and lead author of the study.

"They indicate that the Affordable Care Act is beginning to help people afford the health care they need. We also found sharp declines in the uninsured rate nationwide," Collins said.

The survey suggests there could be continued decreases in the number of people facing health-care financial pressure in coming years, as more people obtain health insurance through elements of the Affordable Care Act, particularly among young and poor adults.

But Commonwealth Fund President Dr. David Blumenthal warned that a Supreme Court case that is attacking one of those major features could undo progress seen in the levels of people strapped by health costs and in number of people who lack insurance.

That case challenges the legality of subsidies given to most customers of the federal Obamacare exchange HealthCare.gov—which sells insurance plans in 37 states—to help them pay for premiums and out-of-pocket health costs.

"I think the Supreme Court decision will have a major effect...if there is a decision in favor of the plaintiffs we would expect, in those states at least in the short term, the situation would revert to the kinds of numbers we saw before the Affordable Care Act," Blumenthal told reporters during a briefing on the survey. A decision in that case is expected in June.

The non-profit Commonwealth Fund, which seeks to promote "high performance health-care system," since 2001 has conducted a biennial survey of health insurance in the United States. The latest survey, which is based on a sample of 6.027 adults ages 19 and older, ran from last July through December.

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That time-fame encompasses in which the government-run Obamacare exchanges had been selling health insurance plans for at least nine months. And it includes a period which more than half of the U.S. states had expanded their Medicaid programs' eligibility to include nearly all poor adults.

Expanded Medicaid eligibility is a key provision of the ACA, but 23 states have yet endorse expansion beyond their currently eligible residents.

"Unfortunately, we're still seeing high uninsured rates in states that haven't expanded Medicaid," said Collins, the study's author.

Despite that, nearly 10 million of Medicaid recipients have been added to the coverage rolls in the past year nationwide.

Those Medicaid enrollments, as well as enrollment in the Obamacare exchanges and other factors, have led to the uninsured rate among people between the age of 19 and 64 dropping to 16 percent— or 29 million people—in the latter half of 2014, according to the Commonwealth Fund survey.

That level is down "from a high of 37 million or 20 percent, in 2010," and from 19 percent in 2012, according to a report on the survey. The group noted that the reduction in the uninsured rate from 2012 to 2014, after the roll-out of the Obamacare exchanges, "is the first statistically significant decline measured by the survey since it began in 2001."

"The uninsured rate is now at its lowest level since 2003," the group said in a report on the the survey.

Young adults saw the biggest decreases in those without insurance, going from 27 percent of those age 19-34 in 2010, to 19 percent by 2014.

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African-Americans and Latinos, two other groups that, like young adults continue to have higher-than-average uninsured rates, saw sharp declines in their uninsured rates since the ACA took effect. African-Americans went from a 24 percent uninsured rate in 2010 to 18 percent last year, while Latinos' uninsured rate fell from 39 percent to 34 percent, according to the survey.

Another steep decline in the uninsured rate came among people earning less than 200 percent of the federal poverty level, or $47,100 for a family of four. The uninsured rate among that group fell from 36 percent in 2010 to 24 percent last year, the survey found.

There was a marked difference in the uninsured rates of states that have expanded Medicaid eligibility and those that have not.

In 24 states that weren't enrolling newly eligible adults in Medicaid as of last July, 35 percent of adults with incomes lower than the poverty level—$11,490 for an individual— were uninsured, according to the survey.

But in the remaining states that had expanded Medicaid by then, the uninsured rate among adults that poor was just 19 percent.

More than 60 percent of the remaining 29 million people who still lack health insurance live in states that haven't expanded their Medicaid programs.