The reform law’s primary goal was supposedly to reduce the number of uninsured and make health insurance cheaper for everyone. The primary methods of ensuring wider coverage were Medicaid eligibility expansion, a mandate that individuals obtain health insurance and a mandate that certain employers provide insurance. The employer mandate has been repeatedly delayed, the individual mandate has resulted in far less coverage than projected and the Medicaid expansion is hung up on constitutional issues, but has resulted, at substantial taxpayer cost, in more covered individuals. An AHRQ Statistical Brief gives a perspective on changes in insurance status during the time the reform law was being implemented. (Stat. Brief) Based on MEPS survey data, the researchers conclude that from early 2013 to early 2014, about 30% of non-Medicare-eligible adults who were uninsured gained coverage, compared to 25% of this category that obtained coverage from early 2012 to early 2013. But there was no change in the likelihood, about 5%, that insured adults would lose coverage in this time period compared to the earlier one. So for a massive amount of spending we raised the likelihood that a non-insured person would get insurance by 5%, and it still is at a very low rate, and did nothing to change the likelihood that an insured adult would lose it. Exactly what the Administration predicted, right?
Older persons and women were more likely to pick up coverage in the study period and Hispanic adults also showed significant gains in insurance status. African-Americans showed the smallest increases in coverage among racial groups. More educated adults showed higher coverage gains than did less educated ones, which may be due to greater awareness of the mandate and the availability of subsidies. Among the health status categories of excellent, very good, good and fair/poor; the largest coverage gains occurred in the good and fair/poor categories, which may have implications for higher health spending but also suggests that people with the greatest need for insurance coverage to help pay for health services were most likely to become newly covered, which is a good thing. Overall, the brief supports the notion that the reform law has done little, considering its cost and the massive disruption it has caused, to achieve the goal of more affordable and more widespread health insurance coverage.