Insurance coverage has increased across all types of insurance since the major provisions of the federal Affordable Care Act took effect, with a total of 16.9 million people becoming newly enrolled through February 2015, according to an estimate based on a survey sample analyzed by RAND Corporation. That is even though coverage through individual non-marketplace policies declined by 1.9 million and coverage from other sources (Medicare, military insurance and state programs) declined by 10 million over the study period.
Nonetheless, they estimate that from September 2013 to February 2015, 22.8 million Americans became newly insured and 5.9 million lost coverage, for a net of 16.9 million newly insured Americans. Among those newly gaining coverage, 9.6 million people enrolled in employer-sponsored health plans, followed by Medicaid (6.5 million), the individual marketplaces (4.1 million), non-marketplace individual plans (1.2 million) and other insurance sources (1.5 million). They also estimate that 125.2 million Americans -- about 80 percent of the non-elderly population that had insurance in September 2013 -- experienced no change in the source of insurance during the period, according to findings in Health Affairs.
RAND estimates 11.2 million Americans are insured through new state and federal marketplaces created under the Affordable Care Act, including 4.1 million who are newly covered and 7.1 million people who transitioned to marketplace plans from another source of coverage. In addition, among the 12.6 million Americans newly enrolled in Medicaid, 6.5 million were previously uninsured and 6.1 million were previously insured.
The paper analyzes information from the RAND Health Reform Opinion Study, a survey that has followed a representative sample of about 1,600 Americans aged 18 to 64 from September 2013 through February 2015. Participants are questioned periodically about whether they have health insurance, their source of insurance and other related questions. None of the other surveys with equally current data on changes in coverage caused by the Affordable Care Act provide longitudinal information about coverage transitions, and none of the other longitudinal surveys are as current, says Katherine Carman, the study's lead author and an economist at RAND.
RAND researchers say the findings that the biggest gain in coverage was from employer-sponsored insurance runs counter to predictions that many employers may quit offering insurance in response to the Affordable Care Act and suggests that regardless of whether that occurs, employer-sponsored coverage will remain the nation's major source of health insurance coverage.
It also runs counter to actual money. If those numbers were true, California's health exchange would not be about to lose $80 million in its first year after the federal safety net expires.