Data show decline in uninsured amid health act rollout

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WASHINGTON -- Evidence has begun to resolve one of the odder controversies surrounding the Affordable Care Act: The new law appears to be achieving its top goal of reducing the number of Americans who lack health insurance.

The dispute over that question is a strange one because the answer would seem to be fairly obvious: Under the Affordable Care Act, the government will spend hundreds of millions of dollars to subsidize families who decide to buy insurance, a product that the vast majority of Americans value highly. Basic economics would seem to say those subsidies would have to increase the number of people buying insurance.

But some of the law's most outspoken critics have insisted that's not the case. The vast majority of people buying insurance under the Affordable Care Act, they have said, are consumers who already had policies, including many whose previous policies were not renewed because they did not comply with the law's new consumer protections.

The question has been: What happens next? As the number of people enrolling under the Affordable Care Act goes up, would the percentage of Americans who lack insurance go down?

Two new sets of data indicate that is now happening.

Gallup, which surveyed about 28,000 Americans concerning their health insurance from Jan. 2 to Feb. 28, found that the percentage who say they lack any form of insurance has dropped significantly, from 18 percent of the U.S. adult population to 15.9 percent. That would translate to between 4 million and 5 million fewer people without insurance. The huge size of Gallup's sample allows for more precise measurements than the sample of 1,000 to 1,500 used in typical polls.

The Gallup survey cannot definitively say the new law caused the change, but the decline started in the last three months of last year, just as the law took effect, and came in the wake of a fairly steady rise that began with the financial crisis late in 2008.

The reduction in those uncovered was greatest among the group the new law targeted: families and individuals with household incomes below $36,000 a year, among whom the share lacking insurance has dropped by 2.8 percentage points.

The other new piece of data comes from the McKinsey Co., which has conducted four surveys of those eligible to sign up for insurance under the Affordable Care Act. McKinsey found that 27 percent of those who signed up on the law's new marketplaces in February were previously uninsured, up from 11 percent in its earlier surveys.

With the deadline for enrollment now three weeks away, the trends that the Gallup and McKinsey surveys point toward likely will accelerate. The experience of Massachusetts, when it rolled out its statewide insurance plan under then-Gov. Mitt Romney, suggests that a lot of people will wait until close to the deadline to sign up.

In the meantime, the surveys show two continued weaknesses for the law's supporters. Gallup's numbers show that Latinos continue to lag behind blacks and non-Latino whites in signing up for coverage, and McKinsey's survey found that more than one-quarter of those who had not yet enrolled for coverage were eligible for subsidies and didn't know it.

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