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Why ACA works better for consumers buying on their own


Commonwealth Fund’s 2016 Biennial Health Insurance Survey found significant improvements in people’s ability to buy health plans on their own after implementation of the ACA insurance reforms.

Since the Affordable Care Act (ACA) took effect, the health insurance market has been working better for consumers buying coverage on their own, especially those with health problems and those with low incomes, according to a new survey.

Commonwealth Fund’s 2016 Biennial Health Insurance Survey found significant improvements in people’s ability to buy health plans on their own after implementation of the ACA insurance reforms.


“The study highlights the strong growth in the use of the individual market by Americans since the ACA market reforms and subsidies went into effect in 2014,” says Sara R. Collins, PhD, vice president, health care coverage & access, The Commonwealth Fund. “The market has evolved from being a place where healthy people and those with sufficient income could buy plans to one where all are offered comprehensive plans, regardless of factors like gender or health status, with income-based financial assistance to offset costs for those eligible.”

Other findings include:

• Among working age adults who tried to buy individual coverage, the percentage who said it was very difficult to find an affordable plan fell by almost half between 2010 and 2016.

• Uninsured rates among lower-income adults have fallen by 17 percentage points since 2010 and are more than 10 percentage points below 2001 levels. "We have seen declines like this among whites, blacks and Latinos," Collins says.

• Adults who reported not getting needed healthcare because of costs fell from a high of 80 million in 2012 to an estimated 63 million in 2016.

• There have been modest improvements in people’s reports of problems paying their medical bills. 

“It is important information to the new Administration, as it was to the prior Administration, to understand how well the ACA is working to improve people’s access to health insurance and healthcare,” Collins says.

Additionally, the survey indicates where there are potential weaknesses in the law and in other types of insurance coverage such as employer coverage, according to Collins.

“The rates of people who cite problems affording plans in the individual market or finding plans that meet their needs have improved but remain high,” she says. “These problems could be remedied by improving the generosity of marketplace subsidies as well as ongoing efforts to help people understand and compare health plans. To cover more people, all states could move to expand their Medicaid programs and increase outreach efforts to those potentially eligible. Immigration reform and lifting restrictions on ACA eligibility for undocumented immigrants could help lower uninsured rates among Latinos.”

Collins cites recent analyses from S&P Global Markets, the American Academy of Actuaries, and HHS have indicated that the individual market and marketplaces are stabilizing in 2017. As open enrollment ends, HHS enrollment reports issued thus far show enrollment outpacing last year’s.

“However, uncertainty about Congress’s and the Administration’s plans with respect to the law add considerable uncertainty for insurers for the 2018 plan year,” she says. “Repealing the ACA’s insurance subsidies and Medicaid expansion without an effective replacement plan will destabilize the marketplaces and cause millions of Americans to lose their insurance, and create economic upheaval and job loss in states.” 

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