Latest Census Estimates Say Little About ACA, But Other Signs are Positive

Back • September 17, 2014 • Uncategorized

On Tuesday, the U.S. Census Bureau released estimates from the American Community Survey (ACS) of health insurance coverage for the Nation and Connecticut. This survey is the best measure we have available to assess trends in health insurance coverage, so there’s been a lot of excitement surrounding this year’s release because many people hoped it would provide insight into the success or failure of health reform in Connecticut. The truth is we won’t learn much about the Affordable Care Act (ACA) from the U.S. Census Bureau’s annual surveys until next year. In the meantime, several other sources offer positive signs that the ACA will soon help many more uninsured Connecticut families gain health coverage.

Why can’t we use this year’s Census release to assess the ACA? Recall that the most important provisions of the Affordable Care Act (ACA) – the establishment of online marketplaces where individuals can buy private health insurance at a reduced price and the expansion of Medicaid to a larger group of low-income adults – didn’t go into effect until January 1, 2014. The data released this week by the Census Bureau report on insurance status in 2013.  Our analysis of Thursday’s release shows that the uninsured rate in Connecticut in 2013 was unchanged from 2012, and slightly higher than 2009. The uninsured rate for children also was unchanged over that same period of time. Connecticut continued to have one of the lowest uninsured rates of any state in the country. Since data on 2014 won’t come out until next September, we won’t be able to use the census to assess the effect of the new marketplace and Medicaid expansion until then.

Importantly though, there are several positive signs from other sources that health reform is already helping to get more Connecticut’s residents covered:

  • On Tuesday, the National Center for Health Statistics released data from the National Health Interview Survey (NHIS) with estimates of health insurance coverage for the first quarter of 2014. These estimates are for the Nation, but they bode well for Connecticut. The NHIS found that in January through March of 2014, the uninsured rate fell relative to the rate for 2013. Furthermore, the decline in the uninsured was greater in states that chose to expand Medicaid – like Connecticut – than in states that did not expand Medicaid.  These are positive trends, especially if we consider that most people who enrolled in new health plans through marketplaces did so toward the end of the open enrollment period in March, and therefore were likely missed by the NHIS.
  • Non-government surveys conducted by Gallup and The Urban Institute corroborate these findings. Both surveys showed that the uninsured rate fell in early 2014, and Urban reported that the effect was largest in states that expanded Medicaid.
  • Enrollment in Connecticut’s HUSKY Program has increased significantly.  Compared to average monthly enrollment in July to September 2013, prior to the open enrollment period for full implementation of new health insurance options,   HUSKY Program enrollment is up by over 100,000 individuals. Most of these new enrollees entered the new “low-income adult” group created by the ACA. Enrollment in private health plans through Connecticut’s insurance marketplace, Access Health CT, also increased in the middle of 2014.

Is the uptick in the uninsured rate from 2009 to 2013 a cause for concern? While it’s difficult to tell, this small increase may be attributable to declines in the number of people who have employer-sponsored health coverage, a trend that our research shows has existed in Connecticut for a decade. In fact, the ACA is designed to combat exactly this problem, by helping middle class and low-income families acquire affordable private or public coverage without depending on employers, and removing some of the burden of health care costs from businesses.

On Thursday, the Census Bureau will release a far more detailed set of data from the ACS, data that will allow us examine trends in the uninsured in each of Connecticut’s large cities, counties, and Congressional districts. These data still won’t tell us much about the ACA; we’ll have to wait for next year for that. The good news is that early data from several other sources taken together suggest that the ACA is helping to move the uninsured rate in Connecticut and the Nation in the right direction.