July 23—A growing number of surveys indicate the number of uninsured has dropped since the launch of healthcare reform’s major enrollment initiatives last fall. However, so far, the rate of reductions appears to fall far below original expectations.

A central goal of the Affordable Care Act (ACA) was to reduce the uninsured rate for adults ages 19-64 through expanded public and private insurance coverage availability. And the number of uninsured has dropped since the insurance marketplaces and expanded Medicaid programs under the ACA began enrollment efforts on Oct. 1, 2014, according to surveys. The degree to which that central goal has been met varies by survey.

This month, several surveys echo positive results. For instance, the Gallup-Healthways survey found the rate of uninsured adults dropped from a high of 18 percent in 2013 to 13.4 percent of adults by mid-2014. Also, a survey by the Commonwealth Fund found that the number of uninsured adults was reduced by 9.5 million since the 2014 enrollments began. The Urban Institute’s Health Reform Monitoring Survey identified a somewhat smaller increase of 8 million adults gaining insurance.

The rates of uninsured declined as well in earlier surveys, such as an April RAND Corporation survey that the share of uninsured dropped from 20.5 percent to 15.8 percent, with a net gain in insured Americans of 9.3 million from September 2013 through mid-March 2014 under the ACA.

18 Million Expected

Amid such large coverage gains, it is easy to forget what the expected coverage gains were when the ACA was enacted. So far—and regardless of the survey examined—it appears the coverage expansion is far short of the 18 million uninsured the nonpartisan Congressional Budget Office expected would gain coverage in 2014 alone.

The Obama administration expects an unknown additional number of people to gain coverage in the remainder of 2014 because of year-round Medicaid enrollment. However, an unknown number of the 8 million marketplace enrollees also are expected to lose coverage due to failure to pay premiums—as much as 20 percent in just the first month of coverage, according to some insurers. The extent to which this has happened is unknown because the administration stopped reporting coverage totals after announcing the 8 million enrollments.

The original ACA coverage figures were later revised downward after the Supreme Court determined Medicaid expansion was optional and the administration delayed numerous aspects of the law, among other changes. However, the cuts to providers that were supposed to be offset by big coverage gains among their patients were never revised. So as the enrollment expectations are revised ever lower, a growing number of advocacy groups for hospitals and other types of providers have been increasingly calling for Congress to revisit the ACA cuts—including $156 billion in hospital Medicare cuts.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare.

Publication Date: Wednesday, July 23, 2014