ACA helps many long-term uninsured get coverage

Sixty-one percent of those who have used coverage they obtained through the Affordable Care Act (ACA) are getting healthcare that they would not have been able to afford or have access to previously, according to a Commonwealth Fund study.

Collins"ACA marketplace and Medicaid coverage is enabling people to get healthcare that many say they could not have gotten before, even among previously insured adults," according to the study's lead author Sara R. Collins, PhD, vice president, health care coverage and access, Commonwealth Fund. "Providing timely access to care is the fundamental purpose of insurance, and in this regard the law is working well for most people who are using their plans."

According to the report, 62% of those newly enrolled in Medicaid were uninsured before they enrolled, and 49% of those were uninsured for more than two years. Among marketplace enrollees, 45% were uninsured before they enrolled, and 59% of those had been uninsured for more than two years.

The report also found that:

• Most recent enrollees in marketplace plans or Medicaid say their ability to get the healthcare they need has improved or stayed the same.

• People with marketplace or Medicaid coverage who looked for new primary care physicians found them relatively easily: nearly three of five ACA enrollees who tried to find a new primary care doctor found it easy to find one.

• Wait times for doctor appointments are comparable to those reported in other surveys; and three of five who needed to see a specialist waited two weeks or less to get an appointment.

• Majorities of marketplace and Medicaid enrollees are satisfied with their insurance.

• At the time of the survey, 12.7% of adults aged 19 to 64 years were uninsured, an estimated decline of 13 million from October 2013, just before the major ACA coverage expansions took effect.

While the ACA has substantially reduced the uninsured rate among working age adults, wide differences persist in the uninsured rates of lower and higher income adults, Collins tells Managed Healthcare Executive.

"Expanding Medicaid coverage in every state would go a long way in moving the uninsured rate down even further for many low income people who are still uninsured," she says.

ACA coverage may be helping bridge gaps when coverage through a job is lost, according to Collins. Thirty-four percent of marketplace enrollees had employer coverage prior to enrolling in marketplace coverage. Seven percent of adults who had employer coverage for less than a year had been enrolled in a marketplace plan prior to getting their employer insurance.

"The ability of adults with marketplace plans and Medicaid to find doctors and get appointments is similar to that of U.S. insured adults overall, which may explain why majorities of enrollees are satisfied with their health insurance," she says. 

However, a minority of those enrolled indicate problems getting care and are less satisfied, according to the report. And many people remain uninsured, especially those with low incomes.

"Ongoing monitoring of the expansions, and adjustments by policy makers and stakeholders, including insurers, will be needed to ensure that families can get high-quality healthcare," Collins says. "Expansion of Medicaid in states that have not yet expanded Medicaid, and improvements in outreach to enroll those remaining uninsured, would go a long way to ensuring that all eligible Americans get covered."