Under the Affordable Care Act (ACA), 20 million Americans have enrolled in health insurance, and the uninsured rate has sunk to the lowest level on record. In New York, our ACA marketplace, the New York State of Health, has enrolled more than 2.8 million New Yorkers into high quality affordable coverage. New York’s uninsurance rate was cut in half between 2013 and 2015.
The ACA provides free coverage or subsidized coverage to the vast majority of New Yorkers obtaining coverage on the NY State of Health marketplace. The new Essential Plan provides free or low-cost coverage to almost 600,000 New Yorkers. The ACA also makes insurance work better for consumers. The extensive list of consumer protections it offers includes: preventive care with no cost-sharing; an end to lifetime and annual limits; a prohibition on discrimination in health care; and no more denials or delays of coverage because of pre-existing conditions.
HCFANY knows that many consumers woke up this morning worrying about whether they will lose the coverage they count on because of threats to repeal the ACA.
HCFANY calls on our elected leaders to assuage their fears and act as soon as practicable to maintain the advances in coverage that New Yorkers have received since the ACA was enacted. New York has always been a leader on health coverage issues. We look to the leadership of New York State to continue to find ways to provide quality, affordable coverage for all New Yorkers.
Last week, the Kaiser Family Foundation (KFF) released a new issue brief examining health coverage by race and ethnicity under the Affordable Care Act (ACA) and its impact on disparities in health coverage. The KFF analysis found that non-elderly people of color have experienced larger coverage gains than non-elderly white people since the implementation of the ACA. According to KFF data, national uninsured rates decreased by 9 percentage points for Hispanic/Latino people, 7 percentage points for Asian people, and 5 percentage points for non-Hispanic Black people from 2013 to 2015 compared to 4 percentage points for white people.
People of color in New York State have experienced similar gains in coverage under the ACA. According to data from the United States Census Bureau, uninsured rates in New York State decreased by 10.2 percentage points for American Indian/Alaskan Native people, 7.3 percentage points for Hispanic/Latino people, 6.3 percentage points for Asian people, and 4.9 percentage points for non-Hispanic Black people from 2013 to 2015 compared to 3.3 percentage points for white people. The only group that did not experience these comparatively larger coverage gains was the Native Hawaiian/Other Pacific Islander population.
This an important step forward in the reduction of health coverage disparities. However, the KFF brief warns that even with the larger coverage gains, people of color are still more likely to be uninsured than white people. Nationally, people of color accounted for more than half of the 28.5 million remaining uninsured in 2015.
Targeted outreach and enrollment efforts to reach the remaining uninsured, many of whom are eligible for coverage as well as financial assistance, could augment these coverage gains and continue the progress toward health coverage equity that has already begun under the ACA.
The Affordable Care Act made a lot of changes – and improvements – to health insurance. But it was also meant to encourage changes in how health care is delivered – the care you get at the hospital, doctor’s office, pharmacy, and other places where people get health care.
Many people have frustrating experiences with health care that go beyond how it’s paid for. Maybe you can’t make an appointment without skipping work, or can’t get your prescription filled on time because of communication problems and end up skipping doses. Maybe you had to get a test done twice because re-doing it was easier than transferring your records to a new physician. Delivery system reform is meant to make the experience of getting health care better – in an ideal world, there would be seamless delivery system that lets doctors and patients focus on their health, not logistics.
HCFANY has produced a new issue brief to help consumers understand what is happening. Delivery system reform could be a great thing for everyone, but changing systems is always hard. A lot of stakeholders have learned to succeed under the status quo, and are afraid of changing how they do business. Consumers need to educate themselves about how delivery reform can benefit them and use their knowledge to encourage reform that benefits patients.
Guest blog by Lois Uttley, MPP, Director of Raising Women’s Voices-NY. Six years after the Affordable Care Act (ACA) was signed into law and three years after the ACA insurance marketplaces opened, the nation’s uninsured rate has dropped to the lowest level ever recorded. Between 2010 and 2016, the percentage of people without health insurance fell by nearly half, from 16 percent to 8.6 percent. The sharp decline is illustrated in this chart from Vox. The previous low of 9.1 percent was recorded in 2015.
The new numbers were released last week by the National Center for Health Statistics, and are based on the National Interview Survey conducted during the first quarter of 2016. The survey uncovered some important variations among population groups when it comes to health insurance. For example:
- Only 5 percent of children 17 and younger are now uninsured. Of those, 42.1 percent had public coverage and 54.9 percent had private coverage.
- Hispanic adults had the greatest decline in un-insurance, going from 40.6 percent in 2013 to 24.5 percent in 2016. But that reduced rate was still much higher than the 2016 rates for non-Hispanic Black (13 percent), white (8.4 percent) and Asian adults (6.7 percent).
States Fully Implementing the ACA Show Biggest Drop In Uninsured
The national survey data also reveal striking disparities between rates of un-insurance in states like New York that have fully implemented the ACA – by expanding their Medicaid programs and creating their own health insurance exchanges, or marketplaces – and those that have refused to do so because of conservative political opposition.
First, let’s look at the impact of a state’s decision to expand Medicaid. In the expansion states, the percentage of uninsured adults (ages 18 to 64) dropped by half — from 18.4 percent in 2013 to 9.2 percent in 2016. By contrast, in non-expansion states, the uninsured rate fell somewhat – from 22.7 percent in 2013 to 16.7 percent in 2016 — but still remained high.
Next, let’s look at the difference in uninsured rates between states that opened their own marketplace (or partnered with the federal government to create a marketplace) and those states that refused to do so, and instead defaulted to having a federally-run marketplace. There have been significant declines in uninsured rates in states with their own marketplaces (from 18.7 percent in 2013 to 9.1 percent in 2016) and in partnership marketplace states (from 17.9 percent in 2013 to 8.2 percent this year).
The survey found a different story in the states with federally-run marketplaces. Although even those states experience a drop in the uninsured rate (from 22 percent to 14.5 percent), the 2016 percentage of residents who remain uninsured is much higher than in the other states.