A large percentage of individuals gaining insurance coverage under the Affordable Care Act (ACA) were previously eligible for Medicaid, a new study has found.
Some 44 percent of those insured since Obamacare came online were previously eligible, according to the study, which was published in the New England Journal of Medicine.
The introduction of Obamacare encouraged those people “to come out of the woodwork,” bringing along many children, said co-author Professor Jonathan Gruber, of the Massachusetts Institute of Technology Department of Economics.
Gruber cited a number of findings as key, including that Obamacare is much more effective in states that “threw themselves into implementing” its provisions, such as those that set up state exchanges and expanded Medicaid.
Another key finding relates to concerns that people might drop their employer-based plans and move to an alternative. That has not happened, the study concluded.
The large number of those previously eligible for Medicaid applying for coverage was surprising, Gruber said.
“Here are all these people who decided to get health insurance,” he told Patient Daily. “The ACA brought them out of the woodwork.”
Repealing and replacing Obamacare could send these individuals back into hiding, Gruber argues.
“The fact that the law is more successful in states that embraced Obamacare more effective might be obvious, but the magnitude is surprising,” he said.
Gruber is worried that Obamacare will be gutted, but he does not know what is going to happen with the Trump administration.
The proposed appointment of Rep. Tom Price as secretary of health gives some indication that Trump intends to forge ahead with replacing Obamacare. Price is one of the authors of the Republican replacement plan; Gruber is a critic of this plan.
“There are no true protections against insurance discrimination, and there is no way to combat the adverse selection that dooms insurance markets,” Gruber said. “Insurance tax credits are flat and therefore not affordable for the sick and poor, and there is nothing in the plan to provide cost control.”
The study, “Disentangling The ACA’s Coverage Effects,” was authored by Gruber, Molly Frean and Dr. Benjamin Sommers. It was published just prior to the Nov. 8 election.
It found that 44 percent of coverage gains came from the enrollment of previously eligible adults and children, including the 2011–2013 early Medicaid expansions. In turn, 19 percent of coverage gains were credited to enrollment of adults who became eligible in 2014.
Enhanced enrollment took place in six early-expansion states — with significant reduction in private coverage as a result of Medicaid expansion.
Additionally, the study found that 37 percent of coverage gains were due to premium subsidies, and that these were nearly twice as effective at increasing coverage in states with state insurance exchanges.
“State implementation continues to strongly affect the success — or shortcomings — of the ACA,” the authors said. “This reality is most obvious in decisions about whether to expand Medicaid under the law, since the lack of expansion in 19 states has left roughly 3 million adults without coverage.”
State policies also affect middle-income families’ ability to sign up for exchange coverage, which has been impaired in some states by legislative barriers to enrollment and lack of outreach, according to the authors.
“Though undermining coverage expansion may be politically expedient in some places, it is indefensible from a public health perspective,” they said.
