Report: Notable Health Insurance Gains Among Young Adults Since Beginning of PPACA Open Enrollment

Earlier this month, the Robert Wood Johnson Foundation and the Urban Institute released estimates indicating 5.4 million previously uninsured adults gained health insurance coverage between September and early March under the Patient Protection and Affordable Care Act.

The Institute has tracked health insurance coverage since the first quarter of 2013 with its Health Reform Monitoring Survey. Last week, based on an analysis of survey data, researchers announced they have a deeper understanding of who the 5.4 million are who gained insurance coverage by early March. According to the Institute, it's important to note these estimates understate the full effects of the PPACA on the uninsured population, since the survey didn't capture the enrollment surge at the end of March and in early April.  Last week, the White House reported a total of 8 million people had enrolled in health plans through the exchanges.

According to the researchers, young adults aged 18 to 30 saw strong gains in coverage, experiencing a 4.3 percentage point drop in their uninsured rate to 19.5 percent between the third quarter of 2013 and the first quarter of this year. These results bode well for the success of the exchanges, says report co-author Genevieve M. Kenney, PhD, co-director and a senior fellow at the Institute's Health Policy Center.

"They're a big chunk of the uninsured," Dr. Kenney says of young adults. "For the [PPACA] to dramatically reduce uninsurance in this country, it has to reduce rates of uninsurance for young adults. I look at these numbers in the context of the other information that's coming out, and I'd say it's an encouraging picture."

People between 18 and 34 — also known as "young invincibles" — have been a focal point of enrollment efforts. Without an adequate amount of young and healthy enrollees, the total amount of premiums health insurers collect for exchange plans would be less than the total healthcare expenses of exchange enrollees, and insurance companies could increase premiums to compensate.

However, a report from the Kaiser Family Foundation found a premium "death spiral" is unlikely to occur and insurers could still expect to earn profits even if only 25 percent of exchange enrollees were young adults. Of the 8 million who enrolled through mid-April, 28 percent are between 18 and 34, according to the White House.

The Health Reform Monitoring Survey analysis also revealed notable coverage gains among families with incomes at or below 138 percent of the federal poverty level (those targeted by Medicaid expansion), who accounted for 2.6 million of the 5.4 million who gained coverage through early March. That demographic saw their uninsured rate drop 4.7 percentage points to 34.5 percent between the third quarter of 2013 and the first quarter of 2014. Middle-income adults who are targeted by the new  subsidies that are available to help cover the cost of exchange plan premiums (those earning up to 400 percent of the poverty level) accounted for another 2.6 million and saw a 3.6 percentage point drop in their uninsured rate to 12.3 percent.

Additionally, non-white, non-Hispanic Americans saw their uninsured rate decline 3.8 percentage points between the third quarter of 2013 and the first quarter of the year, to 16.4 percent.

According to Dr. Kenney, Urban Institute researchers expect to obtain more data in June that will reflect the last surge of PPACA exchange enrollment and will release an updated analysis.

More Articles on PPACA Enrollment:
CMS Establishes Special PPACA Sign-Up Period for High-Risk Pool Enrollees
PPACA Exchanges Still Open for Enrollment in Some States
3 Key Findings on the Shrinking Uninsured Population


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