Federal researchers reported on Tuesday that the number of Americans without health insurance had declined substantially in the first quarter of this year, the first federal measure of the number of uninsured Americans since the Affordable Care Act extended coverage to millions of people in January.
The number of uninsured Americans fell by about 8 percent to 41 million people in the first quarter of this year, compared with 2013, a drop that represented about 3.8 million people and that roughly matched what experts were expecting based on polling by private groups, like Gallup. The survey also measured physical health but found little evidence of change.
The findings were part of the National Health Interview Survey, a nationally representative examination that is considered a gold standard by researchers. It interviewed about 27,000 people in the first quarter, fewer than Gallup, which interviewed 45,000 people in the second quarter alone. But researchers say it is considered particularly trustworthy because federal interviewers conduct the survey in Americans’ homes. It also sets a federal level that others can use as a benchmark.
Larry Levitt, a director at the Program for the Study of Health Reform and Private Insurance at the Kaiser Family Foundation, a health research organization, said the first-quarter findings “dramatically understate the effect” of the law, as almost half of the people who signed up for insurance during the open enrollment period did so in March and did not get their insurance cards until later. Private surveys have shown that there were eight million to 10 million fewer uninsured by the second quarter, he said.
“Regardless of what you think of the A.C.A., there should be no doubt at this point that the law is increasing the number of people insured,” he said.
Katherine Baicker, a professor of health economics at the Harvard School of Public Health, said of the finding: “That sounds reasonably consistent with what had been expected.”
There was a sharper drop in the share of uninsured in states that expandedMedicaid than in those that did not, reflecting the broad uptake of the government insurance program since the law took effect. The share of uninsured among 18- to 64-year-olds fell by nearly three percentage points to 15.7 percent in the first quarter in states that expanded Medicaid, compared with a drop of about one percentage point to 21.5 percent in states that did not, a decline that was not statistically significant.
Analysts have scrambled in recent months to measure the effects of the Affordable Care Act, President Obama’s signature health insurance overhaul, by drawing on data trickling in from the early months of this year from health insurance plans, hospital associations and other sources. But experts caution that those ups and downs will not say much about the change, and that a meaningful analysis will only be possible once data from later months accumulate.
“It is too early,” said Jonathan Gruber, an economist at M.I.T. whose work was used in shaping the law. “This is really a three-year process of implementation,” he said, pointing out that federal estimates assume the law will take three years to take full effect, similar to the timing aroundhealth care overhaul in Massachusetts. “Trying to draw strong conclusions from one quarter of one year is impossible.”
Indeed, the survey measured a number of other basic health indicators, but only one of them registered any real change: About 2.9 percent of respondents said they had experienced a “serious psychological stress during the past 30 days,” down from 3.7 percent in 2013.
That finding resembled a pattern in one of the most revealing studies of the effects of health insurance on a population in which researchers found that Medicaid coverage for poor people in Oregon improved mental health and financial security, but not physical health.
The nation’s uninsured rate stood at about 13 percent at the time of the survey, and has declined gradually from about 16 percent in 2010, the highest share of uninsured since the National Health Interview Survey began tracking it in 1997. Many experts attribute the changes to the health care law, but there is not definitive proof that the law was the driver.
The most significant decline in the share of the uninsured was among 19- to 25-year-olds, 21 percent of whom were uninsured in the first quarter, down from 27 percent in 2013. The share of uninsured for that age group has been declining since 2010, when a provision in the law began allowing dependents to stay on their parents’ insurance policies until their 26th birthday. Experts are also looking at how much Americans are using the health care system as a measure of the law’s progress.
In an analysis of data from the National Association of Insurance Commissioners, which receives information on hundreds of health insurance plans across the country, the Robert Wood Johnson Foundation, which funds research and programs to improve health, found a 20 percent increase in the rate of hospital admissions among people in the individual market — the place where many of the newly insured are covered — in the second quarter compared with the second quarter of 2013. (The data did not measure public insurance programs like Medicaid, which is also playing a big role in the overhaul.) There were also small increases in outpatient care (5.3 percent) and physician visits (1.9 percent) among that population.
Katherine Hempstead, who directs research on health insurance coverage at the foundation and who analyzed the data, said the rise appeared to indicate that some of the newly insured — many of whom did not previously have insurance because they could not afford it or because they had pre-existing conditions — were starting to use the health care system.
Date: September 16, 2014