Uninsured ranks fall faster in states with own health exchanges

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WASHINGTON -- New surveys provide a glimpse into how many Americans have gained health insurance since the federal and state marketplaces opened in October.

Gallup reported Wednesday that the 21 states and the District of Columbia that fully embraced the new health care law by setting up their own exchanges and expanding their Medicaid programs saw their uninsured rate drop this year three times faster than the states that did not: a decline of 2.5 percentage points, compared with a 0.8-point drop in the 29 other states.

Last week, Gallup said the uninsured rate had fallen from 17.1 percent to 15.6 percent between the fourth quarter of 2013 and the first quarter of 2014 -- the lowest rate since 2008.

Another Gallup poll, also released Wednesday, found that 4 percent of Americans said they are newly insured this year, with slightly more than half (2.1 percent) reporting that they received coverage through an exchange. The rest said they received coverage from another source, which could be either Medicaid, an employer or a health plan purchased directly from an insurer. An additional 7.5 percent said they had a new health plan that replaced an old one.

The poll also found that newly insured people are, on average, younger than the rest of the population. People ages 18 to 29 accounted for 30 percent of the newly insured, although they represent just 21 percent of the population. But the newly insured in this age bracket were much more likely to get coverage off the exchange (24 percent exchange vs. 37 percent off-exchange).

Gallup found that all the newly insured also tend to be lower-income and are more likely to have gotten coverage through the exchanges, in which people earning as much as 400 percent of the federal poverty level can receive subsidies to help buy insurance. The Department of Health and Human Services has previously said 83 percent of those purchasing through exchanges received financial assistance.

On Tuesday, the Urban Institute offered further details on its finding that the number of uninsured non-elderly adults fell by 5.4 million people between September and early March. The institute said states that expanded their Medicaid programs saw their uninsured rate drop 4 percent, while states that didn't expand had a much slower drop of 1.5 percent. The expansion states also did a better job of covering young adults and Hispanics in particular -- demographics targeted by supporters of the health care law.

More surveys are expected on how the act is changing the uninsured rate. One will come from the Census Bureau.

Bureau director John Thompson said Wednesday he is confident that new changes in the wording of survey questions on health insurance will not diminish its ability to measure the Affordable Care Act's impact.

Mr. Thompson, responding to critics, said the survey questions were rephrased specifically to establish a benchmark for how many people were uninsured in 2013, the year before the health insurance mandate took effect, so comparisons can be made in future years.

Concerns, first reported in The New York Times, have arisen that changes in the phrasing of one survey's questions may make future comparisons more difficult. Health insurance act critics have accused the Census Bureau of working to fudge the numbers, so the White House can claim more success than is merited.

But Mr. Thompson said bureau demographers had been preparing for many years to modify the questions, and the changes should make it easier to measure the law's impact, not harder.

"I can assure you, I have had no discussions of this with the White House, or with anyone else in the administration," Mr. Thompson said in an interview. "This has been a scientific process, and that's the way we operate. ... We pride ourselves on being a statistical agency that produces objective, nonpartisan and high-quality information."

The concerns have emerged over changes made to one of three separate surveys the government conducts with questions about who has health insurance.

The most current and complete measure of how many people are uninsured is from the Health Interview Survey, conducted by the National Center for Health Statistics. Researchers focusing on geographical comparisons find the American Community Survey helpful to see variations down to neighborhood level.


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