The passage of the Affordable Care Act in 2009 (signed into law in March of 2010) was a watershed moment in US history.
Regardless of your perspective on the politics of that debate and its outcome, it has had a dramatic impact on healthcare in the US. One metric of that impact is the number of uninsured people in our country. Most Americans agree that healthcare coverage is important both to health and to financial stability, and although discussions of universal coverage can be contentious, most agree that it is a laudable goal to insure as many Americans as possible. A PEW poll earlier this year found that 60% of Americans say the government should be responsible for ensuring health care coverage for all Americans, compared with 38% who say this should not be the government’s responsibility.
Earlier this month (November 2017) the CDC released the National Health Interview Survey on health insurance coverage in the US and the results are striking.
- This year there are 28.8 million people (9% of the population) of all ages who are uninsured. This compares to 48.6 million in 2010 (15.7% of the population) in 2010.
- Among people age 18 – 64 5% are uninsured.
- 5% of children are uninsured.
- The poor and the nearly poor are 3 times more likely to be uninsured but the rate of uninsured among the poor is down from over 40% in 2010 to 24% in 2016, likely due to Medicaid expansion in most states.
- Children in poverty are twice as likely to be uninsured but their rate of uninsured is down from 12% in 2010 to 7% in 2016
- In states which expanded Medicaid the uninsured dropped from 18.4% to 8%.
- In states which did not expand Medicaid the uninsured dropped from 22.7% to 19%.
There are other interesting tidbits in the data as well. For instance, the rate of uninsured in New York is 7%, but in Texas it is 25%. 8.8 million people get their insurance on the healthcare exchanges (“marketplace”) and more employers and individuals are choosing high deductible plans (up from 39% to 43% in the last year alone).
This kind of information should inform all of us (including our policy makers) as we consider whether to repeal and replace, adjust or improve the Affordable Care Act. However, it is common sense (and a concept supported by every healthcare organization in the country) that changes that result in loss of insurance or loss of important benefits within an insurance plan is detrimental to the health of individuals, to the public health, and to the healthcare delivery system.