Health Insurance

Tracking how the uninsured fared, and changed, since Obamacare took effect

Obamacare on life support?

Obamacare hasn't been a cure-all for America's uninsured population — but it sure has changed the numbers of people without health coverage, and what the remaining uninsured look like.

Two new surveys out Thursday shed new light on the effects of the Affordable Care Act.

One details a dramatic drop in the uninsured population in California, the nation's most populous state, and one that has fully embraced Obamacare's tools for expanding health coverage.

The other survey describes how people nationally who still lack health insurance after Obamacare's first two years are more likely to be Hispanic, be very poor, be under the age of 35 and work for a small business.

Uninsured say coverage 'too expensive'

The first survey comes from the Kaiser Family Foundation, which has been tracking the effects of the ACA in California since 2013 in a series of interviews with the uninsured. That year was the last one before individual health insurance plans went on sale on government-run Obamacare marketplaces nationwide, and also the last year before the ACA rule mandating nearly every American to have some form of health coverage or pay a fine took effect.

Kaiser's survey in 2014 found that 58 percent of the uninsured population in California had gained health coverage since the year before. In 2015, the survey found that 68 percent of the previously uninsured had obtained such coverage.

The new survey released Thursday found that in 2016, 72 percent of previously uninsured Californians had become covered.

The percentage was even higher if uninsured undocumented workers, who are not eligible for either Medicaid or Obamacare plans, are not considered. Among previously uninsured, eligible Californians, 78 percent are now insured in some manner, Kaiser found.

When currently uninsured people were asked why they still don't have coverage, almost half said insurance is too expensive for them.

Kaiser's report on the survey noted that largest share of the recently insured residents — 33 percent — have become covered through Medi-Cal, the state's Medicaid program that covers primarily low-income people. Another 21 percent are insured through employer-based health plans, and just 11 percent are insured through plans sold on Covered California, the state-run Obamacare exchange. The rest of the recently insured said they have other forms of coverage.

Kaiser's survey also found that recently insured Californians "are more likely to report that their health needs are being met today than when they were uninsured" — 77 percent this year, compared to 49 percent in 2013. Nearly 80 percent of the recently insured said their experiences with their current coverage has been positive.

Huge differences in Medicaid expansion states

The second report released Thursday comes from the Commonwealth Fund, with the title, "Who Are the Remaining Uninsured and Why Haven't They Signed Up for Coverage."

The group notes that about 20 million Americans have gained health coverage since 2010, when the ACA first began taking effect, with a provision that allowed people under the age of 26 to stay on their parents' health plans.

"Yet an estimated 24 million people still lack health insurance," the report said.

Of that 24 million, about 21 million of them — 88 percent — have incomes below about $16,243, were young adults, worked at small firms, and/or are Latino, according to the Commonwealth Fund.

In 2013, Latinos, who have the highest rates of uninsurance of any ethnic group, comprised 29 percent of the uninsured population.

Latinos now make up 40 percent of the uninsured, according to the report, which notes that is "more than twice their representation in the overall population."

At the same time, whites, who previously made up half of the uninsured, now comprise 41 percent of the uninsured.

The report noted that 34 percent of the remaining uninsured have incomes low enough to qualify them for Medicaid, but live in one of the 20 states that have not adopted Obamacare's provision that allows nearly all poor adults to be covered by that program, with significant federal financial assistance.

In states that did not expand Medicaid under Obamacare, 41 percent of adults with incomes below $16,243 were uninsured as of the summer of 2013. By 2016, the uninsured rate among that population had fallen just to 35 percent this year — which is actually 1 percent more than in the past two years.

However, in the states that did expand Medicaid, the uninsured rate among poor adults fell from 30 percent in 2013, to only 17 percent this year.

The report found that almost two-thirds of uninsured adults who knew about Obamacare insurance marketplaces, which offer subsidized coverage to low- and middle-income people, had not visited those exchanges "because they did not think they would be able to afford coverage."

At the same time, the report said, more than half of the uninsured adults actually had incomes in a range that made them eligible for federal subsidies that could reduce the cost of their Obamacare exchange plan coverage.