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Breaking down the enrollment numbers

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How many of those who purchased health insurance under the Affordable Care Act (ACA) already had coverage before the law went into effect and how many were previously uninsured?

That question has been batted about for months. Now a study has broken down the enrollment numbers.

A recent study by the Kaiser Family Foundation (KFF) provides the best estimate to date of the proportion of private health plan enrollees under the ACA who previously lacked health insurance and therefore would be gaining coverage under the new law. Based on their survey of adults who purchase their own insurance, KFF finds that 57 percent of private plan enrollees were previously uninsured.

WalletHub has combined that information with data on the number of new Medicaid recipients and private plan enrollees under the ACA. Here is WalletHub’s initial projection of uninsured rates post-ACA for 43 states and the District of Columbia.

The states with the lowest rate of uninsured after the ACA took effect were Massachusetts, Rhode Island and the District of Columbia. Texas, Louisiana and Mississippi were the states with the highest rates of uninsured after the enrollment period was over.

Other key findings from the WalletHub report include:

  • The national uninsured rate for non-elderly population decreased from 17.87 percent to 14.22 percent with around 12 million individuals gaining coverage.
  • States that expanded Medicaid have an average uninsured rate of 10.22 percent compared with 15.87 percent for states that did not expand Medicaid.
  • “Blue states” have fewer uninsured residents with an average rank of 15.9 compared to 28.52 for “Red states” (lower is better).
  • Across all states, West Virginia and Oregon experienced the greatest decline in their uninsured rate (around 10 percentage point reduction).
  • Nearly 1 in 4 Texans lack health insurance (highest rate of uninsured) compared to just 1 in 100 residents of Massachusetts (lowest rate of uninsured).
  • Of the states that expanded Medicaid coverage, the increase in Medicaid enrollment on a per capita basis in West Virginia (the state with the highest increase) is 11 times greater than in Illinois (the state with the smallest increase).
  • The increase in private plan enrollment in Florida on a per capita basis is 11 times greater than in Massachusetts, likely because Massachusetts had fewer uninsured individuals to start with.

Now that these number questions have been answered, some big questions still to be answered are whether costs will go up and whether we will see the day when every American has coverage.

WalletHub posed this question to some ACA-watchers. Joel Shalowitz of Northwestern University, summed it up like this: “Even for those eligible, an obstacle may be cost. Let’s start with what premiums and out of pocket expenses will be for next year’s exchange offerings. I expect costs to go up for three reasons. First, the exchange population is older than expected. Second, costs for this population has been higher than average, particularly for expensive pharmaceuticals. Third, plans only had a couple months of data to project next year’s expenses. The prudent business decision given these facts is to raise premiums and/or out of pocket expenses. It may still be cheaper to pay a penalty than have insurance.”

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Susan Rupe is assistant editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Connect with Susan →

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