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States hold key to giving health coverage to more Americans

States hold key to giving health coverage to more Americans

The percentage of U.S. adults without health insurance has fallen by more than 40% due to the health care reform law, and it could go even lower depending on what states do.

During the first quarter of 2016, 9.9% of adults — individuals age 18 through 64 — were uninsured, a steep decline from the last quarter of 2013, when 17.6% of adults were uninsured, according to a survey funded by the Robert Wood Johnson Foundation and the Urban Institute and released last week.

That reduction “is a very big deal. Reducing the number of uninsured was one of the main things the Affordable Care Act was to achieve, and that goal has been met,” said Kathy Hempstead, senior adviser for health care in Princeton, New Jersey, for the Robert Wood Johnson Foundation.

That decline, experts say, is the direct result of two Affordable Care Act provisions: mandating, effective Jan. 1, 2014, federal premium subsidies for lower-income uninsured — those earning between 100% and 400% of the federal poverty level — to buy coverage in ACA-created public exchanges; and giving states authority, with generous federal subsidies, to ease eligibility requirements for their Medicaid programs.

About 30 states have expanded their Medicaid programs under the ACA to allow enrollment of individuals earning up to 138% of the federal poverty level, up from 100% of federal poverty level.

And if, as is likely, more states ease Medicaid eligibility requirements, that 9.9% uninsured rate could go even lower.

“Another big chunk of the uninsured would get coverage,” Ms. Hempstead said.

States that have changed their laws to allow more people to qualify for Medicaid have far lower uninsured rates — an average of 7.3% in the first quarter of 2016 compared with the average 14.9% in states that have not eased Medicaid eligibility requirements, according to the survey.

Still, while the decline in the uninsured is welcome, other key problems with the nation's health insurance system continue.

“We still have to deal with rising costs,” noted Steve Wojcik, vice president of public policy at the National Business Group on Health in Washington.

“Cost and quality issues still remain,” added James Gelfand, senior vice president of health policy at the ERISA Industry Committee in Washington.

Indeed, numerous studies predict that health care coverage costs are on the upswing.

For example, while plan costs rose an average of 3.2% in 2015, Aon Hewitt consultants project an average increase of 4.1% this year driven by several factors, including soaring prescription drug prices.

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