Millions of Americans Enroll for Health Insurance

The initial health insurance enrollment period in the Affordable Care Act has come and gone. Early figures are promising. They show 7.5 million Americans have enrolled in private insurance through the federal and state marketplace. This figure met both administration goals and Congressional Budget Office projections for the initial ACA open enrollment period.
That number continues to grow as the deadline was extended to mid-April for those who had technological enrollment challenges. In addition, multiple millions have gained health care coverage through the ACA’s Medicaid expansion (in those states that expanded their Medicaid program).

Uninsured Rate Lowest in over 5 Years
Overall, the RAND Corporation, an independent analysis think tank, estimates that up to 9.3 million more people had health care coverage in March 2014 (compared to September 2013). This growth was from a variety of sources – ACA marketplace enrollments, Medicaid increases, and increases in employer-sponsored health insurance.

The RAND study does not include most of March’s ACA enrollment surge, which was substantial. The net gain in those with health insurance is likely significantly larger. Some analysts believe the total ACA affect on health insurance coverage could be in the range of 14 million to 34 million from marketplace purchases, off-marketplace purchases, and increased Medicaid enrollment.
chart of percentage uninsured in the US from 2008-2014These figures, of course, will be the subject of much debate. ACA opponents will naturally treat any positive numbers with skepticism. There will be many theories as to what caused people to purchase insurance, what caused some not to, the makeup (especially age) of those who purchased insurance, and the effect of any ACA provisions. Already many folks think the requirement of most Americans to have health insurance was stronger than thought. In conjunction with an improving economy, it may have led more employers to provide insurance. 

But as important as this debate and analysis is, it is ultimately noise to the most important result – the number of people without health insurance coverage is declining. RAND found the uninsured rate fell by 23% from September 2013 to March 2014. A Gallup survey found the uninsured rate in the first three months of 2014 was its lowest in over five years (see chart). Bottom line, this means more people have access to needed care, and more people will lead healthier lives.

Still More To Do
While the initial results of ACA enrollment are encouraging and the ACA seems to be putting the uninsured rate on the right path, there is more to do. More people need health coverage and access to needed care and services. Many are confused by their ACA alternatives, what they can afford, and what they need – and initial data show these are the people most in need of coverage.
Continual outreach and education is needed to further increase enrollment and provide as many people as possible the health insurance coverage they lack. These are all important “to dos” for rural people and rural places that have, as we have documented, higher uninsured rates and higher rates of most diseases and health conditions. Getting more people enrolled in any health coverage will benefit rural America.