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ACA uncertainty impacts rate of insured: What health execs should know


A Gallup-Healthways poll shows it will be important to monitor the uninsured trends in the coming months as the ACA hangs in the balance.

The slight rise of the uninsured rate could be attributable to the uncertainty surrounding the long-term future of the Affordable Care Act (ACA), according to a new poll. 

The percentage of U.S. adults without health insurance rose slightly in the first quarter of 2017, to 11.3%, according to a Gallup-Healthways poll. The uninsured rate was 10.9% in each of the last two quarters of 2016, a record low since Gallup and Healthways began tracking insurance coverage in 2008.

The results for the first quarter of 2017 are based on 44,596 interviews with U.S. adults aged 18 and older from January 2 to March 31, conducted as part of the Gallup-Healthways Well-Being Index. Gallup and Healthways have asked a random sample of at least 500 U.S. adults each day since January 2008 whether they have health insurance.

Additionally, the percentage of uninsured has dropped sharply among young adults since 2013, according to the poll, since the requirement to obtain health insurance coverage took effect. Adults aged 18 to 25 have seen more than a seven-percentage-point decline in their uninsured rate, which may be, in part, attributable to an ACA provision that allows young adults to remain on their parents’ health insurance until age 26. Meanwhile, those aged 26 to 34 have seen a nearly 10-point drop.

Fewer coverage options, fewer insured?


It will be important to monitor the uninsured trends in the coming months as potential changes to the ACA unfold, according to Dan Witters, research director for the Gallup-Healthways Well-Being Index. “If coverage options and premiums do change, members of Congress from both parties may show a renewed urgency to address the healthcare issue,” he says.

“The healthcare legislation debate remains unsettled, and it is unclear how soon President Trump and Congress will attempt to pass revised legislation,” Witters adds.

“Our research will continue to closely monitor the levels of those who are uninsured versus insured to understand any impact of revised healthcare laws," he says. "Several insurers have announced that they are abandoning some health exchanges in 2018, suggesting that coverage options could diminish and premiums could surge in the near future in some states.”

Next: Biggest insured rate changes



Biggest insured rate changes

Since the ACA’s individual mandate took effect, the largest change in plan type or source of insurance has been among adults who fully pay for their own plans, according to Witters. This group has grown by just over three points since the last quarter of 2013, from 17.6% to 20.7%, likely reflecting purchases of health coverage on the marketplace insurance exchanges introduced by the ACA, he says.

“Medicaid shows the second-largest increase among insurance sources,” Witters says. “The nearly two-point increase in this type of coverage, which caters to lower-income and disabled Americans, likely stems from the ACA’s Medicaid expansion provision that offered additional federal funding to states that expanded Medicaid eligibility."

According to Witter, managed care executives can measurably impact these populations by promoting low-cost, effective interventions that focus on lifestyle change to mitigate risk, integrating disease management and patient education, and adopting a population health approach.

"After campaigning on a promise to repeal the ACA, Trump and Republicans in Congress have so far failed to offer an alternative that satisfies their various constituencies", according to Witters.

“The GOP healthcare plan was panned by conservative Republicans who demanded additional reforms, while Democrats and moderate Republicans balked at Congressional Budget Office estimates indicating millions of Americans could lose their coverage under the plan,” he says. “The onus remains on the administration to either assimilate the ACA into their long-term strategy or offer a viable alternative in a timely manner.”

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