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Study: Uninsured Rate Dropped Significantly In First 2 Years Of Obamacare

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Commonwealth Fund
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Florida saw an “impressive” drop in the rate of uninsured adults in 2014 and 2015, the first two years of full implementation of the Affordable Care Act, according to a study released Wednesday.

Between 2013 and 2015, Florida’s rate of uninsured adults plummeted nine percentage points, from 29 percent to 20 percent, according to the study.  Health-care advocacy groups were aggressive in outreach, getting 1.5 million Floridians enrolled in health plans through the federal Marketplace at More than 90 percent of Florida enrollees qualified for subsidies.

Nine other states saw their rate of uninsured adults drop even more than Florida, according to the study called “A Long Way in a Short Time.”  They all took federal funds to expand their Medicaid programs to more low-income adults and families.

Overall, the national rate of uninsured people below retirement age fell from 17 percent to 11 percent, the study reported.  (If the Medicare age group is added in, the uninsured rate stands at 8.6 percent, according to the National Center for Health Statistics, part of the CDC.    

The Commonwealth Fund, which sponsored the study released today, called the rapid decline in the rate of uninsured “historic” and said it made a significant difference in access to needed care. In a call with reporters Tuesday, Commonwealth Fund President David Blumenthal made clear that he hopes policy makers are paying attention.

“It is important to hold on to these gains and continue to make progress in assuring that people can get and afford the health care they need,” said Blumenthal, a physician. “The bottom line is, whatever policy changes are undertaken, they should continue to move in the direction of increased coverage, better access to care and improved quality, affordability and equity.”

As he was saying this, theMiami Herald reported, a protest by Miami residents who have been able to get insurance because of the Affordable Care Act was held at the office of U.S. Sen. Marco Rubio, a Republican critic of the law. He released a written statement through a spokesman: "Senator Rubio looks forward to repealing Obamacare and replacing it with a system that puts patients first and provides more choices and better care at lower costs."

In a similar vein, President-elect Donald Trump has vowed to abolish the law and replace it with a tax deduction, Medicaid overhaul and removal of some limits on markets set by states. A Rand Corp. analysis in September calculated that if Trump were elected and enacted his plan, 20 million Americans would lose their health coverage.

Nevertheless, Florida and other states that have seen their uninsured rates drop under the Affordable Care Act voted for Trump. 

When a reporter asked about the disconnect, Blumenthal called it “perplexing.” It seems at variance with the behavior of Medicare beneficiaries, AIDS patients and others who vote in line with protecting their health care.

“I don’t have a degree in psychology or sociology,” he said. 

While the fund is non-partisan, it finances health-policy research as part of its mission “to promote a high-performing health care system.”

“A large body of research has shown that health insurance coverage is linked to better health,” Blumenthal said. He cited a study from the Institute of Medicine that found uninsured people have a higher mortality risk than those with insurance.

The foundation has been issuing Health System Performance Scorecards for a decade to help policymakers and the public track progress. The findings are especially important now, the study’s authors say, “as a new administration and Congress prepare to take office and the ACA faces an uncertain future.”  

Among the states, the one that received special commendation for improvement was Kentucky. In the two-year period, it had a decline in the rate of uninsured adults of 13 percentage points, says study author Susan L. Hayes.

“Florida’s nine-percentage-point reduction in its adult uninsured rate was impressive, but there were nine states that had 10- to 13-percentage-point declines,” Hayes said. “Those nine states all had expanded Medicaid as soon as federal resources became available in January 2014.”

The Supreme Court ruled that states could choose whether to accept federal funds to cover more low-income adults and families under the Medicaid program, which is jointly funded by the states and federal government. The federal government pays about 60 percent of the tab in Florida, but would have paid 100 percent for the added beneficiaries for the first two years, tapering to 90 percent in the year 2020.

Health economists had predicted that Medicaid expansion would bring Florida $51 billion over 10 years, with ripple effects in the economy. But legislators said in rejecting the money that they didn’t believe the federal commitment would endure. Since last month’s election, it appears that the funding flow could, indeed, be cut off.

Sara Collins, a Commonwealth vice president who was another author on the new study, said the Medicaid-expansion states saw marked improvement in people’s ability to actually get health care, not just coverage.

In 2013, at the beginning of the period studied, federal surveys found that 34 percent of adults in both Kentucky and Florida reported that they had forgone needed health care because of the cost. Then Kentucky expanded Medicaid, while Florida did not.

By 2015, Collins said, the cost-related problems had declined in both states, but by a much greater margin in Kentucky, she said.  

Besides Kentucky, the states that dropped at least 10 percentage points were New Mexico, Nevada, Arkansas, California, Oregon, Washington, West Virginia, and Rhode Island.

In the new “scorecard” released by the Commonwealth Fund, Florida is tied for 41st place. Despite its steep drop in uninsured for both adults and children, it is still in the bottom quartile.

During the two years covered by the study, the rate of uninsured children in Florida dropped from 12 percent to 7 percent, the Commonwealth Fund reported.  The national average dropped from 8 percent to 5 percent.

Children’s uninsured rates were lower than working age adults’ because of the Children’s Health Insurance Program, or CHIP. It has provided about $20 billion over 10 yearsto help states insure children who aren’t eligible for Medicaid but whose families cannot afford private insurance.

In 2015, CHIP was reauthorized for two years. It is up for renewal in the 2017 Congress.

The Commonwealth Fund report says that surveys of adults asking whether they had gone without care in the past year because of its cost found that the U.S. rate dropped over the two-year period to 13 percent, down by three percentage points. Florida’s rate dropped by four percentage points, to 17 percent.

By ethnicity, Hispanics in Florida had the largest drop in the adult uninsured rate over the two-year period, by 15 percentage points. For blacks, the drop was by 11 percentage points and for whites, 7 points. Even so, Hispanics still had the highest rate of adult uninsured, at 28 percent. For blacks, it was 22 percent, and for whites, 15 percent.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.