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Obamacare led to similar drops in uninsured rate across all income groups

Obamacare health insurance enrollment
Lucy Nicholson | Reuters

A new report on the effects of health insurance expansion under Obamacare found that every income group "experienced significant and similar drops" in the rate of uninsured people.

"The uninsured rate fell by around 40 percent for Americans in all income groups for 2010 through 2015, including individuals with incomes above 400 percent of the federal poverty level," the U.S. Health and Human Services Department said Thursday.

That 400 percent level is significant because individuals with households incomes above that amount — $97,000 for a family of four — are not eligible for federal tax credits that reduce the cost of monthly health insurance premiums for plans sold on Obamacare marketplaces. In other words, people above that income level have to pay full price for their Obamacare plans.

The HHS report, which comes about a month before the Nov. 1 kickoff of open enrollment in Obamacare health plans, also looked at how implementation of the Affordable Care Act from 2010 onward affected the uninsured rate of groups by age, geography and race.

The 18-to-25-year-old age group, which has had the greatest percentage of uninsured people, saw a 52 percent reduction in the number of those without health insurance, the report said. The age group with the smallest reduction in the uninsured was 26- to 34-year-olds, who had a 36 percent reduction.

Uninsured rates in urban or metropolitan areas saw their uninsured rates decline by 42 percent, slightly more than the 39 percent drop seen in rural areas.

Among ethnic groups, Asians had the biggest drop in their uninsured rates, at 59 percent. The next largest drop was among blacks, at 47 percent, followed closely by whites at 46 percent. Hispanics, who had the largest percentage of uninsured of any ethnic group, saw the smallest reduction in that rate: 35 percent.

"Regardless of your income, age, geography, or race, everyone is gaining access to coverage or better coverage under the Affordable Care Act," said HHS Secretary Sylvia Burwell.

The report noted that one of the few groups that had a "notably smaller decline in uninsured rates was Americans living in poverty in states that chose not to expand Medicaid," the joint federal-state health coverage program that covers primarily poor people. Nineteen states have not expanded Medicaid eligibility to include nearly all poor adults, as was authorized and largely federally funded by the ACA.

In Medicaid expansion states, the overall uninsured rate of residents declined by almost 50 percent. But in non-expansion states, the uninsured rates dropped by less than 32 percent.

HHS, citing an Urban Institute estimate, said that if the non-expansion states adopted expansion, an additional 4.1 million people would gain health coverage.

The ACA led to reductions in the uninsured rates through several avenues. First, the law allowed adults below the age of 26 to remain on their parents' health plans. The law then, beginning in 2014, mandated that nearly all Americans have some form of health insurance or be subject to a tax penalty.

Obamacare also authorized the creation of government-run marketplaces, or exchanges, to sell private health plans, with people with low or moderate incomes eligible for subsidies to reduce their monthly premium payments, and in many cases to reduce their out-of-pocket health costs. The law also mandated that employers with 50 or more full-time workers offer them health coverage or face a fine. And it allowed states to expand Medicaid.

According to recent surveys, the national uninsured rate has fallen to 9.1 percent this year. Before passage of the ACA, the uninsured rate was just under 16 percent.