Impact of Affordable Care Act: Millions Have Gained Insurance Coverage

1. Exhibit 1. Over 25 Million People Estimated to Have Insurance Under the Provisions of the Affordable Care Act, as of March 2015 • Millions of people who have gained coverage or enrolled in a new plan under the Affordable Care Act * Change in number of young adults ages 19–25 covered under a parent’s policy from 2010–2014. ** Number of Americans that have selected or been automatically reenrolled into a 2015 health insurance plan through the Health Insurance Marketplace (11/15/14–2/15/15), including Special Enrollment Period activity reported through Feb. 22, 2015. *** Increase in Medicaid and CHIP enrollment between October 2013and December 2014. Sources: CMWF Biennial Health Insurance Surveys (2010 and 2014) , HHS-ASPE, and CMS.

2. Exhibit 2. The Number of Uninsured Working-Age Adults Has Declined by an Estimated 7 Million to 11 Million Millions of nonelderly adults* who are uninsured Note: Most survey estimates are for adults ages 18–64. The Commonwealth Fund surveys’ estimates are for adults ages 19–64. * Kaiser Family Foundation Pre-ACA estimate calculated using their Dec. 2014 estimate that 30 million people remained uninsured and adding the estimate that 11 million people gained coverage. Source: The Commonwealth Fund; Centers for Disease Control; RAND.

3. Exhibit 3. Young Adults Have Made the Greatest Gains in Coverage of Any Age Group Since 2010 Percent of adults ages 19–64 who are uninsured Source: The Commonwealth Fund Biennial Health Insurance Surveys (2001, 2003, 2005, 2010, 2012, and 2014).

4. Exhibit 4. People with Incomes Under $48,000 for a Family of Four Experienced the Largest Declines in Uninsured Rates Percent of adults ages 19–64 who are uninsured <$47,100 $47,100+ Note: FPL refers to federal poverty level. Income levels are for a family of four in 2013. Source: The Commonwealth Fund Biennial Health Insurance Surveys (2001, 2003, 2005, 2010, 2012, and 2014).

5. Exhibit 5. Uninsured Rates Declined Among Non-Hispanic Whites, Blacks, and Latinos in 2014 Percent of adults ages 19–64 who are uninsured Source: The Commonwealth Fund Biennial Health Insurance Surveys (2010, 2012, and 2014).

6. Exhibit 6. More Than Three-Quarters of Adults with New Coverage Said They Were Very or Somewhat Satisfied with It Overall, how satisfied are you with this new health insurance? Not at all satisfied Not very satisfied Somewhat satisfied Very satisfied 14 78 13 79 16 77 11 84 19 73 10 87 15 78 15 73 10 82 27 65 9 85 17 74 13 82 Adults ages 19–64 who selected a private plan or enrolled in Medicaid through marketplace or have had Medicaid for less than 1 year Notes: Segments may not sum to indicated total because of rounding. Bars may not sum to 100 percent because of don’t know/refusal to respond. FPL refers to federal poverty level. * This includes some individuals who enrolled in Medicaid outside of the marketplace, but have been covered by Medicaid for less than 1 year. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, April–June 2014.

7. Exhibit 7. Three of Five Adults with New Coverage Said They Had Used Their Plan; of Those, Three of Five Said They Would Not Have Been Able to Access or Afford This Care Before Have you used your new health insurance plan to visit a doctor, hospital, or other health care provider, or to pay for prescription drugs? Prior to getting your new health insurance plan, would you have been able to access and/or afford this care? Yes 36% No 34% Yes 60% No 62% Don’t know or refused 2% Plan has not yet gone into effect 6% Adults ages 19–64 who have used new health insurance plan Adults ages 19–64 who selected a private plan or enrolled in Medicaid through the marketplace or have had Medicaid for less than 1 year Note: Segments may not sum to 100 percent because of rounding. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, April–June 2014.

8. Exhibit 8. One of Five Adults with New Coverage Tried to Find a Primary Care Doctor; Three-Quarters Found It Easy or Somewhat Easy to Find One Since getting your new health plan or Medicaid coverage, have you tried to find a new primary care doctor or general doctor? How easy or difficult was it for you to find a new primary care doctor or general doctor? Very easy 39% Somewhat easy 36% No 78% Yes 21% Somewhat difficult 10% Don’t know or refused 1% Could not find a doctor 7% Very difficult 7% Adults ages 19–64 who selected a private plan or enrolled in Medicaid through marketplace or have had Medicaid for less than 1 year Adults ages 19–64 who have tried to find new primary care or general doctor Note: Segments may not sum to 100 percent because of rounding. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, April–June 2014.

9. Exhibit 9. The Number of Adults Reporting Not Getting Needed Care Because of Cost Declined in 2014 Percent of adults ages 19–64 Source: The Commonwealth Fund Biennial Health Insurance Surveys (2003, 2005, 2010, 2012, and 2014).

10. Exhibit 10. The Number of Adults Reporting Medical Bill Problems Declined in 2014 Percent of adults ages 19–64 * Subtotals may not sum to total: respondents who answered “don’t know” or refused are included in the distribution but not reported. Source: The Commonwealth Fund Biennial Health Insurance Surveys (2005, 2010, 2012, and 2014).

11. Exhibit 11. No Change in Health Insurance Marketplace Premiums Nationally in 2014–2015, But State-to-State Variation • Decrease or no increase in average premiums • 1%–5% increase in average premiums • 6%–9% increase in average premiums • 10%+ increase in average premiums • No data available Note: Data from Idaho and New York are not available. Source: J. R. Gabel et al., Analysis Finds No Nationwide Increase in Health Insurance Marketplace Premiums, The Commonwealth Fund, Dec. 2014, available at: http://www.commonwealthfund.org/publications/blog/2014/dec/zero-inflation-nationwide-for-marketplace-premiums.

12. Exhibit 12. Three of Five Adults with Marketplace Coverage Found It Easy to Pay Their Premiums How easy or difficult is it for you to afford the premium costs for your health insurance? Very difficult or impossible Somewhat easy Very easy Somewhat difficult All adults 25 • 75 • 37 • 61 Adults with incomes below 250% FPL • 38 • 62 • 33 • 65 Adults with incomes of 250% FPL or more • 20 • 79 • 44 • 54 Percent adults ages 19–64 who pay all or some of premium Notes: FPL refers to federal poverty level. 250% of FPL is $28,725 for an individual or $58,875 for a family of four. Bars may not sum to 100 percent because of “don’t know” responses or refusal to respond; segments may not sum to subtotals because of rounding. Source: The Commonwealth Fund Affordable Care Act Tracking Survey, April–June 2014.

13. Exhibit 13. State Action on Health Insurance Marketplaces and Medicaid Expansion, as of March 2015 State-run marketplace (13 states + D.C.) Expanding (22 states + D.C.) State-run marketplace using Healthcare.gov (3) Approved customized Medicaid expansion (6) State-federal partnership exchange; state conducting plan management and consumer assistance (7) Medicaid expansion under discussion (6) State-run small business marketplace; federal government running individual marketplace (2) Not expanding (16) Federally facilitated marketplace; state conducting plan management (7) Federally facilitated exchange (18) * Adults in Wisconsin are eligible for Medicaid up to 100% of federal poverty level. Note: CMS has approved waivers for expansion with variation in Arkansas, Indiana, Iowa, Michigan, and Pennsylvania. New Hampshire’s waiver is under review but the state is enrolling people. Source: The Commonwealth Fund, http://www.commonwealthfund.org/interactives-and-data/maps-and-data/state-exchange-map; http://www.commonwealthfund.org/interactives-and-data/maps-and-data/medicaid-expansion-map

14. Exhibit 14. Growth in Employer Health Insurance Premiums Slowed Over 2010–2013 Compared with 2003–2010 in 31 States and D.C. 2003–2010 2010–2013 WA WA NH NH ME ME VT VT MT MT ND ND MN MN OR OR MA MA ID ID NY NY SD WI WI SD MI WY MI WY RI RI PA CT CT PA IA IA NE NJ NJ NE NV NV OH OH UT IL IN DE DE IN IL UT CO MD MD CO CA WV CA WV VA VA KS KS MO MO KY DC DC KY NC NC TN TN OK OK AZ AZ AR SC NM AR SC NM GA GA AL AL MS MS LA TX TX LA FL FL HI HI AK AK Average annual growth rate <4.0% 4.0%–4.9% 5.0%–5.9% 6.0% or more Notes: Single-person plans; growth rates calculated as average annual compound growth rate. Sources: C. Schoen, D. C. Radley, and S. R. Collins, State Trends in the Cost of Employer Health Insurance Coverage, 2003–2013, The Commonwealth Fund, Jan. 2015; 2003, 2010, 2013 Medical Expenditure Panel Survey–Insurance Component.

15. Exhibit 15. Medicare Shared Savings Program: Year One Performance Results, 2013 220 Medicare Shared Savings Program ACOs Source: Centers for Medicare and Medicaid Services.

16. Exhibit 16. All Cause, 30-Day Hospital Readmission Rate Source: Patrick Conway; Office of Information Products and Data Analytics, Centers for Medicare and Medicaid Services.