The Center's work on 'Insurance Coverage' Issues

Early Data Show Decline in Uninsured Under Health Reform

April 9, 2014 at 11:07 am

How many uninsured people have gained health coverage since the Affordable Care Act’s major coverage expansions took effect January 1?  While 2014 health coverage data from the major federal surveys won’t be available until mid-to-late next year, new data from three independent surveys suggest that health reform’s Medicaid expansion and subsidized marketplace coverage likely are already making substantial progress in reducing the ranks of the uninsured.

  • The latest results from the RAND Health Reform Opinion Study, released yesterday, show that the share of adults aged 18-64 without insurance fell by 4.7 percentage points between September 2013 and March 2014, from 20.5 percent to 15.8 percent.  The number of uninsured adults aged 18-64 fell by 9.3 million over this period, from 40.7 million to 31.4 million.
  • Data from the Urban Institute’s Health Reform Monitoring Survey show that the uninsured rate among adults aged 18-64 fell by 2.7 percentage points between the third quarter of 2013 and the first quarter of 2014, from 17.9 percent to 15.2 percent.  The number of uninsured non-elderly adults fell by 5.4 million.  Moreover, the Urban Institute notes that its results likely understate the coverage gains as they do not include the “enrollment surge that occurred at the end of the open enrollment period”; 80 percent of the survey for the first quarter of 2014 was conducted before March 6.
  • Poll results from the Gallup-Healthways Well-Being Index show that the share of adults (including those aged 65 and above) without health coverage fell by 1.5 percentage points between the fourth quarter of 2013 and the first quarter of 2014, from 17.1 percent to 15.6 percent — the lowest rate since the last quarter of 2008.  (We calculate, based on Census data, that the percentage-point reduction translates to a drop in the number of uninsured adults of roughly 3.6 million.)

Recent Spending Cuts Outweigh Tax Increases 3 to 1

March 20, 2014 at 12:33 pm

We noted Policy savings to reduce deficits largely come from program cutsyesterday that legislative changes account for most of the nearly $5 trillion decline since 2010 in projected deficits for the 2015-2024 decade.  Those legislative changes, in turn, consisted mostly of program cuts, which outweigh revenue increases 77 percent to 23 percent (see graph).

This lopsided 3 to 1 ratio strongly suggests that further deficit reduction should place greater emphasis on revenue increases.  And the deductions, exclusions, preferential rates, and other tax breaks known collectively as tax expenditures are ripe for reform.

The four major pieces of deficit-reduction legislation enacted since the fall of 2010 were the Budget Control Act of 2011, the American Taxpayer Relief Act of 2012, the Bipartisan Budget Act of 2013 (also known as the Murray-Ryan deal), and this year’s farm bill.

Altogether, they cut projected deficits over 2015-2024 by $4.1 trillion: about $3.2 trillion from program cuts (including the associated interest savings) and $950 billion from higher revenues (again, including the interest savings).

See our new paper for details.

Projected Ten-Year Deficits Down by Nearly $5 Trillion, Mostly Due to Legislative Changes

March 19, 2014 at 11:28 am

Since 2010, projected ten-year deficits over the 2015-2024 decade have shrunk by almost $5.0 trillion, $4.1 trillion of which is due to four pieces of legislation enacted in the intervening years, according to our new paper:

Some 77 percent of the savings from those pieces of legislation — which include the Budget Control Act of 2011 and the American Taxpayer Relief Act of 2012 — come from program cuts, 23 percent from revenue increases.  Projected deficits have also fallen because of a dramatic slowdown in health spending.

The reduction in ten-year deficits improves the long-term budget picture as well, relative to the outlook of several years ago.  In 2010 we projected that, under current budget policies, the debt held by the public would reach 218 percent of gross domestic product (GDP) by 2040.  Our new estimate, derived from the Congressional Budget Office’s (CBO) new ten-year baseline, shows debt at slightly less than 110 percent of GDP in 2040.

Although far more favorable than those of 2010, our current projections still show that significantly more deficit reduction will ultimately be needed to put the debt on a stable path as a share of the economy over the medium and long term.  But, because the economy has not yet fully recovered from the Great Recession, the desirability of additional long-term deficit reduction should not displace the need for up-front job and income creation.  The appropriate mix is one of short-term measures to bolster the still-sluggish recovery and increases in investments that can boost long-term growth (e.g., infrastructure, education, early childhood programs, and basic research), along with revenue and spending measures that reduce mid- and long-term deficits and take effect as the economy strengthens.

This interactive graph shows how legislative and other changes since 2010 have produced the nearly $5 trillion improvement.

Obama Budget Would Improve Access to Health Care for Underserved Populations

March 14, 2014 at 2:07 pm

As health reform enables millions of uninsured Americans to gain health insurance, the need for preventive and primary care services and those who provide them will continue to grow.  The President’s 2015 budget includes a new initiative to strengthen the health workforce — particularly for underserved areas and populations with shortages of providers — and ensure adequate payments for primary care physicians, physician assistants, and nurse practitioners who see Medicaid patients.  It deserves Congress’ approval.

The initiative would:

  • Expand the National Health Service Corps, which boosts the number of health care providers in high-need communities through scholarships and other kinds of support.  The program would receive an extra $4 billion over fiscal years 2015 through 2020, allowing it to support 15,000 providers (up from the current 9,000) delivering care to more than 16 million people.
  • Provide $5.2 billion over ten years for a new competitive grant program for medical residency positions that would encourage primary care physicians to practice in rural and other underserved areas.
  • Continue Medicaid’s enhanced payment rate for primary care services, scheduled to end on December 31, 2014, through December 2015, at a total cost of $5.4 billion.  This provision requires states to pay providers at the Medicare rate; the federal government covers 100 percent of the boost from the state’s regular Medicaid rate. The President’s budget also would extend the enhanced Medicaid rate beyond primary care physicians to include physician assistants and nurse practitioners.

CBO: Five-Year Individual Mandate Delay Means 13 Million More Uninsured, Higher Premiums

March 12, 2014 at 1:19 pm

Delaying health reform’s individual mandate for five years, as a House bill would do to offset the cost of permanently cancelling scheduled cuts in Medicare payments to physicians, would mean about 13 million more uninsured Americans in 2018 compared to current law, with similar increases in most years that the mandate isn’t in effect, a new Congressional Budget Office (CBO) analysis reveals.

Consistent with earlier CBO and outside analyses of the effects of repealing the mandate entirely, the new CBO figures show that the bill — which the House is expected to vote on Friday — would undermine health reform’s implementation and produce serious harm.

Without the individual mandate, many fewer uninsured people would enroll in job-based coverage, Medicaid and the Children’s Health Insurance Program (CHIP), subsidized private coverage through health reform’s new marketplaces, and other sources of health coverage.

Outside experts examining permanent repeal of the mandate have produced similar estimates:

  • Urban Institute: 13.4 million to 15.8 million more uninsured without a mandate.
  • Massachusetts Institute of Technology (MIT) health economist Jonathan Gruber: 24 million more uninsured without a mandate.
  • RAND Corporation: 12.5 million more uninsured without a mandate.
  • Lewin Group: 7.8 million more uninsured without a mandate.

Along with the sizable coverage losses, CBO estimates that a five-year mandate delay would raise premiums in the individual market (both inside and outside the marketplaces) by 10 to 20 percent in 2018 compared to current law (with similar increases in most years the mandate isn’t in effect).

Consistent with its previous estimates, CBO likely assumes that without the individual mandate, healthier and younger individuals would be more likely to remain uninsured, leaving the pool of people enrolled in individual-market coverage less healthy and hence more costly to cover.  That drives up premiums.

Again, CBO’s estimates are similar to independent estimates of the impact of permanently repealing the individual mandate:

  • Urban Institute: roughly 10-25 percent increase in average premiums without a mandate.
  • MIT’s Gruber: 27 percent increase in average premiums without a mandate.
  • RAND: 9.3 percent increase in average premiums without a mandate.
  • Lewin: 12.6 percent increase in average premiums without a mandate.