Insurance Transitions Following the First ACA Open Enrollment Period

Insurance Transitions Following the First ACA Open Enrollment Period

Katherine Grace Carman
Christine Eibner
Copyright Date: 2015
Published by: RAND Corporation
Pages: 22
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  • Book Info
    Insurance Transitions Following the First ACA Open Enrollment Period
    Book Description:

    While most of the Affordable Care Act’s coverage-related provisions took effect in January 2014, there is limited information on insurance transitions that occurred in the period before and after these changes became operational. This report examines insurance transitions between September 2013 and November 2014 using longitudinal data from the RAND Health Reform Opinion Study.

    eISBN: 978-0-8330-9136-9
    Subjects: Health Sciences, Business

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-3)
  3. Abstract
    (pp. iv-4)
  4. Table of Contents
    (pp. v-5)
  5. Figures and Tables
    (pp. vi-6)
  6. Acknowledgments
    (pp. vii-7)
  7. Abbreviations
    (pp. viii-8)
  8. Introduction
    (pp. 1-1)

    The Affordable Care Act (ACA) extended health insurance coverage to millions of Americans through Medicaid expansions in participating states, new regulations to make private insurance coverage accessible to all applicants, and federal tax credits for low-to-moderate-income individuals without affordable employer coverage. The law also created new inducements to enroll in insurance by imposing penalties on most individuals who remain uninsured. Previous research on the effects of the ACA on health insurance has found large gains in insurance coverage since the main provisions of the law took effect in January 2014. For example, using data from the Gallup-Healthways Well-Being Index, Sommers...

  9. Methods
    (pp. 2-3)

    We tracked transitions in insurance coverage using the RAND Health Reform Opinion Study (RHROS), a longitudinal survey that followed a cohort of people from September 2013 through November 2014. While our analysis focused on transitions between September 2013 and November 2014, the month immediately before the ACA’s first open enrollment period and again immediately before the ACA’s second open enrollment period, we also looked at transitions over the entire period.

    The RHROS is conducted using the RAND American Life Panel (ALP), a nationally representative panel of individuals who regularly participate in surveys. The RHROS has been conducting monthly surveys with...

  10. Results
    (pp. 4-8)

    Table 1 highlights the net gains and losses in coverage. We estimate that, on net, 10.8 million people gained coverage through Medicaid, 7.6 million people gained coverage in the Marketplaces, and 6.6 million people gained coverage through ESI between September 2013 and November 2014. Coverage through self-pay policies and through other sources (such as Medicare, military insurance, and other state policies) declined by 1.3 million and 10.7 million, respectively. A number of factors contribute to the large drop in other sources of coverage, including the elimination of small state safety net programs that coincided with the increase in Medicaid eligibility....

  11. Limitations
    (pp. 9-9)

    These data provide a unique opportunity to study insurance transitions across a broad representative sample of the United States, but there are some limitations. First, the sample size is limited to only 1,628 observations. The small sample size reduces the precision of our estimates and leads to relatively wide margins of error. For example, our estimate that approximately 12.9 million people gained insurance coverage between 2013 and 2014 has a margin of error of 6 million. Second, respondents are asked to report their own insurance status. Some respondents may not correctly report the type of insurance coverage they have; in...

  12. Discussion
    (pp. 10-11)

    We found that 20.4 million people became newly insured and 7.4 million become uninsured between September 2013 and November 2014, for a net gain in insurance of 12.9 million among adults ages 18 to 64. These estimates correspond to a reduction in the uninsurance rate among this age group from 20.3 percent to 13.7 percent. The net gains that we estimated are similar to those estimated in prior cross-sectional studies (Sommers et al., 2014; Collins et al., 2014; and Long et al., 2014), with slight differences due to sampling variability, differences in the way questions were worded, and differences in...

  13. Conclusions
    (pp. 12-12)

    The ACA has greatly expanded health insurance coverage in the United States, with minimal effect on those who were insured before the major provisions of the law took effect. In addition, the law has expanded coverage using all parts of the health insurance system, including employer plans, Medicaid, and the newly created Marketplaces. Understanding these transitions is critical to assess the effects of the law and to determining how many people may need assistance as they gain access to new or new types of insurance. In particular, those who became insured for the first time may need help navigating the...

  14. References
    (pp. 13-14)