New data out this morning from the National Center for Health Statistics show that health insurance coverage increased sharply in the first quarter of 2014, reflecting the significant progress made in expanding access to affordable insurance coverage during the first part of the Affordable Care Act’s inaugural open enrollment period.
These first official data on insurance coverage in 2014 do not capture the full scope of the gains in insurance coverage that have occurred so far in 2014 because most of the underlying interviews occurred well before the “March surge” in plan selections on the Health Insurance Marketplace. But when taken together with private survey data showing that coverage continued to expand in the second quarter of 2014, other recent data showing continued slow growth in health care costs, and ongoing improvements in health care quality, the overall picture is clear: the Affordable Care Act is working and well on its way to ensuring that all Americans have access to high-quality, affordable health care.
Today’s results from NCHS show large coverage gains, with larger gains ahead.
In detail, today’s results from the NCHS’ National Health Interview Survey (NHIS) show that the share of Americans without health insurance averaged 13.1 percent over the first quarter of 2014, down from an average of 14.4 percent during 2013, a reduction corresponding to approximately 4 million people. The 13.1 percent uninsurance rate recorded for the first quarter of 2014 is lower than any annual uninsurance rate recorded by the NHIS since it began using its current design in 1997.
As striking as this reduction is, it dramatically understates the actual gains in insurance coverage so far in 2014. The interviews reflected in today’s results were spread evenly over January, February, and March 2014. As a result, the vast majority of the survey interviews occurred before the surge in Marketplace plan selections that occurred in March; 3.8 million people selected a Marketplace plan after March 1,with many in the last week before the end of open enrollment on March 31. Similarly, these results only partially capture the steady increase in Medicaid enrollment during the first quarter.
For this reason, private surveys from the Urban Institute, Gallup/Healthways, and the Commonwealth Fund in which interviews occurred entirely after the end of open enrollment have consistently shown much larger gains in insurance coverage. An analysis published last month in the New England Journal of Medicine based on the Gallup/Healthways data estimated that coverage gains reached 10.3 million by the middle of 2014.
It is also important to note that, when examined over a common time period, the results from these private surveys look very similar to today’s NHIS release. For example, earlier estimates from the Gallup/Healthways survey, which, like the NHIS, conducts interviews on a continuous basis, showed that insurance coverage among adults was 1.7 percentage points above its 2013 average in the first quarter of 2014, nearly identical to the corresponding NHIS estimate released today.
In sum, it appears very likely that when NHIS estimates encompassing the second quarter of 2014 are released in December, they will show considerably larger coverage gains than today’s release, gains similar to the estimates from the private surveys described above.
While incomplete, today’s results do provide several insights about how the expansion of coverage under the Affordable Care Act unfolded through the first quarter of 2014:
The gains in this report are on top of very large coverage gains among young adults from 2010 through 2013, gains that are largely attributable to a provision of the Affordable Care Act that permits young adults to remain on their parents’ insurance policies until they turn 26. From 2010 through the first quarter of 2014, the insurance rate among young adults ages 19-25 (the full group affected by this earlier Affordable Care Act provision) has increased by a total of 13 percentage points.
New data from the Census Bureau confirm earlier increases in coverage from 2012 to 2013.
Also this morning, the Census Bureau released data from its American Community Survey showing that the share of Americans without health insurance declined from 14.8 percent in 2012 to 14.5 percent in 2013, which brought the uninsurance rate in 2013 below the 14.6 percent rate recorded in 2008, at the start of the Great Recession. Today’s results from the American Community Survey corroborated earlier results from the National Health Interview Survey indicating that insurance coverage had approximately returned to its pre-recession levels by 2013. That recovery in insurance coverage is thanks in significant part to the dramatic expansion in insurance coverage among young adults since 2010 that was described above and some States’ early expansions of Medicaid.
Today’s release from Census also provided a first look at results from the re-designed health insurance questions in the Current Population Survey Annual Social and Economic Supplement. The re-designed questions, which are the fruit of a long-term research effort by the Census Bureau aimed at improving how it measures health insurance coverage, will provide a stronger basis for measuring insurance coverage in the years ahead. Because of the methodological change, however, the Current Population Survey estimates released today cannot be used to assess trends in health insurance coverage relative to prior years. In detail, Census released two sets of Current Population Survey estimates today:
Estimated share of Americans uninsured for all of 2013: As it has in past years, the Census released an estimate of the share of Americans who were uninsured for the entirety of 2013. Because of the question changes, this estimate is not comparable to prior years’ estimates, but it will provide an improved baseline for evaluating changes in full-year coverage from 2013 to 2014 in next year’s Census release.
Estimated share of Americans uninsured at a point in time in early 2014: The Census also released (via the National Center for Health Statistics) an estimate of insurance coverage at the time of this year’s Annual Social and Economic Supplement interviews, which occurred in February, March, and April 2014. The Census Bureau has not previously published this type of point-in-time estimate using the Current Population Survey, so this estimate also cannot be used to evaluate trends in coverage.