A survey finds the law gives Americans access they couldn’t previously get.

BY NOAM N. LEVEY
More than 60% of working-age Americans who signed up for Medicaid or a private health plan through the Affordable Care Act are getting healthcare that they couldn’t previously get, a new nationwide survey indicates.
And consumers are broadly satisfied with the new coverage, despite some cost challenges and an ongoing Republican campaign to discredit the law.
Overall, 82% of American adults enrolled in private or government coverage through the health law said they were “somewhat” or “very” satisfied, according to the report from the nonprofit Commonwealth Fund.
“If the fundamental purpose of health insurance is to provide people with adequate access to needed healthcare, then it would seem that, on balance, the Affordable Care Act’s coverage expansions are working well for most of the people who have enrolled in them,” the report concluded.
The findings paralleled a recent nationwide survey by the nonprofit Kaiser Family Foundation, which found that two-thirds of people in a marketplace plan created through the law rated their coverage “excellent” or “good.”
Unlike the new report, the Kaiser survey did not include people newly enrolled in Medicaid through the law, which is often called Obamacare.
New Medicaid enrollees are even happier with their health coverage than Americans in commercial health plans purchased through the marketplaces, with 88% reporting they are somewhat or very satisfied, the Commonwealth Fund found.
Americans with employer-provided health plans — which have lower premiums and deductibles than many marketplace plans — are the happiest, with 90% reporting satisfaction with their coverage.
The high marks are not universal, cautioned fund Vice President Sara Collins, the report’s lead author.
Some consumers who had coverage before the health law was implemented have seen their premiums and deductibles increase as insurers have absorbed millions of new consumers, many of whom could not obtain health insurance previously because they had a preexisting medical condition.
The Commonwealth Fund, like Kaiser, has found that many Americans are concerned about the cost of their healthcare.
Nearly half of consumers in marketplace plans reported difficulty paying premiums in 2015. The fund plans to update those findings with 2016 numbers later this year.
“This [report] doesn’t mean that the law is working well for every single person,” Collins said. “But in general, it seems to be enabling people to get the healthcare that they need.”
More than 8 in 10 people said their ability to get needed care has either improved or stayed the same since they enrolled in coverage through the health law.
The law allows Americans who don't get health benefits at work to shop among plans on state-based exchanges operated by the federal government or by the states themselves.
Consumers making less than four times the federal poverty level — about $47,000 for a single adult or $97,000 for a family of four — qualify for subsidies. Insurers must provide a basic set of benefits and cannot turn away consumers, even if they are sick.
Very-low-income Americans in most states can enroll in the government's Medicaid program at virtually no cost, an option provided by the health law that leaders in 31 states and the District of Columbia have elected to make available to their residents.
The dual coverage expansions have led to the largest drop in the nation’s uninsured rate in at least half a century, surveys show.
The new Commonwealth Fund survey found that 45% of adults enrolled in a marketplace plan in 2016 and 62% of adults newly covered by Medicaid were previously uninsured.
More state leaders are now considering Medicaid expansions, including in very conservative states such as Oklahoma.
And enrollment in the marketplaces has been increasing, albeit at a slower rate than initially forecast; there are about 12 million people in marketplace plans.
But the law remains a political hot button, with Republican congressional leaders and presumptive GOP presidential nominee Donald Trump promising full repeal.
At the same time, many insurers are seeking significant premium increases next year, in part because enrollees in marketplace plans are sicker and more expensive than they anticipated.
The Commonwealth Fund survey was conducted between Feb. 2 and April 5 among a random, nationally representative sample of 4,802 adults ages 19 to 64. It has a margin of error of plus or minus 2 percentage points. noam.levey@latimes.com  


JOE RAEDLE Getty Images
ALBERTO ABIN leaves the UniVista Insurance office in Miami after looking for a health plan under Obama-care, which allows Americans who don’t get coverage at work to shop among plans on state-based exchanges.



JOE RAEDLE Getty Images
ALINA NURIEVA, right, talks with an insurance agent in Miami as she picks a health plan in 2015.

Not me. My daughter. They will help her if she sees the doctor they tell her to after having her doctor approved upon sign up. Comes time to schedule surgery, sorry, your doctor is not in our network. You can see this one, this one, or this one. One isn't even practicing anymore. The one she can see, she can't see for months. Then start the whole process over. Exams, CT scan, blood work, and biopsy. Then surgery. All of this has already been done, and paid for out of pocket. We are looking at CANCER in a vibrant, productive, 30 year old woman! And my little girl!!
According to the doctors in MEXICO, the prognosis is good if this is handled quickly. We will keep the insurance for now in case she needs some chemo treatment afterwards. If they will even help then. I have been helping her pay for this, since she works, and it isn't affordable.

Not me. My daughter. They will help her if she sees the doctor they tell her to after having her doctor approved upon sign up. Comes time to schedule surgery, sorry, your doctor is not in our network. You can see this one, this one, or this one. One isn't even practicing anymore. The one she can see, she can't see for months. Then start the whole process over. Exams, CT scan, blood work, and biopsy. Then surgery. All of this has already been done, and paid for out of pocket. We are looking at CANCER in a vibrant, productive, 30 year old woman! And my little girl!!
According to the doctors in MEXICO, the prognosis is good if this is handled quickly. We will keep the insurance for now in case she needs some chemo treatment afterwards. If they will even help then. I have been helping her pay for this, since she works, and it isn't affordable.

A survey finds the law gives Americans access they couldn’t previously get.

BY NOAM N. LEVEY
More than 60% of working-age Americans who signed up for Medicaid or a private health plan through the Affordable Care Act are getting healthcare that they couldn’t previously get, a new nationwide survey indicates.
And consumers are broadly satisfied with the new coverage, despite some cost challenges and an ongoing Republican campaign to discredit the law.
Overall, 82% of American adults enrolled in private or government coverage through the health law said they were “somewhat” or “very” satisfied, according to the report from the nonprofit Commonwealth Fund.
“If the fundamental purpose of health insurance is to provide people with adequate access to needed healthcare, then it would seem that, on balance, the Affordable Care Act’s coverage expansions are working well for most of the people who have enrolled in them,” the report concluded.
The findings paralleled a recent nationwide survey by the nonprofit Kaiser Family Foundation, which found that two-thirds of people in a marketplace plan created through the law rated their coverage “excellent” or “good.”
Unlike the new report, the Kaiser survey did not include people newly enrolled in Medicaid through the law, which is often called Obamacare.
New Medicaid enrollees are even happier with their health coverage than Americans in commercial health plans purchased through the marketplaces, with 88% reporting they are somewhat or very satisfied, the Commonwealth Fund found.
Americans with employer-provided health plans — which have lower premiums and deductibles than many marketplace plans — are the happiest, with 90% reporting satisfaction with their coverage.
The high marks are not universal, cautioned fund Vice President Sara Collins, the report’s lead author.
Some consumers who had coverage before the health law was implemented have seen their premiums and deductibles increase as insurers have absorbed millions of new consumers, many of whom could not obtain health insurance previously because they had a preexisting medical condition.
The Commonwealth Fund, like Kaiser, has found that many Americans are concerned about the cost of their healthcare.
Nearly half of consumers in marketplace plans reported difficulty paying premiums in 2015. The fund plans to update those findings with 2016 numbers later this year.
“This [report] doesn’t mean that the law is working well for every single person,” Collins said. “But in general, it seems to be enabling people to get the healthcare that they need.”
More than 8 in 10 people said their ability to get needed care has either improved or stayed the same since they enrolled in coverage through the health law.
The law allows Americans who don't get health benefits at work to shop among plans on state-based exchanges operated by the federal government or by the states themselves.
Consumers making less than four times the federal poverty level — about $47,000 for a single adult or $97,000 for a family of four — qualify for subsidies. Insurers must provide a basic set of benefits and cannot turn away consumers, even if they are sick.
Very-low-income Americans in most states can enroll in the government's Medicaid program at virtually no cost, an option provided by the health law that leaders in 31 states and the District of Columbia have elected to make available to their residents.
The dual coverage expansions have led to the largest drop in the nation’s uninsured rate in at least half a century, surveys show.
The new Commonwealth Fund survey found that 45% of adults enrolled in a marketplace plan in 2016 and 62% of adults newly covered by Medicaid were previously uninsured.
More state leaders are now considering Medicaid expansions, including in very conservative states such as Oklahoma.
And enrollment in the marketplaces has been increasing, albeit at a slower rate than initially forecast; there are about 12 million people in marketplace plans.
But the law remains a political hot button, with Republican congressional leaders and presumptive GOP presidential nominee Donald Trump promising full repeal.
At the same time, many insurers are seeking significant premium increases next year, in part because enrollees in marketplace plans are sicker and more expensive than they anticipated.
The Commonwealth Fund survey was conducted between Feb. 2 and April 5 among a random, nationally representative sample of 4,802 adults ages 19 to 64. It has a margin of error of plus or minus 2 percentage points. noam.levey@latimes.com  


JOE RAEDLE Getty Images
ALBERTO ABIN leaves the UniVista Insurance office in Miami after looking for a health plan under Obama-care, which allows Americans who don’t get coverage at work to shop among plans on state-based exchanges.



JOE RAEDLE Getty Images
ALINA NURIEVA, right, talks with an insurance agent in Miami as she picks a health plan in 2015.

At what costs?
As a presidential candidate, Barack Obama promised that his health reform plan would "lower premiums by up to $2,500 for a typical family." So it's not surprising that many people are dismayed by the rising costs under the health reform law he subsequently signed.

But the president and the lawmakers who created Obamacare were always far more focused on increasing coverage than on reducing costs. That's why two of the law's central provisions were expanding Medicaid eligibility and creating new government-run exchanges offering subsidizing health plans.

Given that focus, one natural question since the Obamacare rollout ended in April has been, "How much did Obamacare increase health insurance coverage?" While various guesstimates have been offered, we can now answer that question with real numbers.

The latest enrollment data for Medicaid and private plans show that the number of Americans with coverage increased by 8.5 million during the first half of 2014. However, 6.1 million of that number were new Medicaid enrollees, with private-market enrollment increasing by 2.4 million individuals.

In other words, 71 percent of the total coverage gain came from Obamacare expanding Medicaid to able-bodied, working-age adults.

Digging further into the private market data, we find that the number of people covered by individual-market plans increased by 6.2 million, but that the number of those with employer-group coverage declined by 3.8 million. Thus, the drop in employment-based coverage offset 61 percent of the growth in individual-market coverage, resulting in a net increase in private coverage of only about 2.4 million.

The Medicaid numbers show that enrollment growth there was almost entirely due to Obamacare expanding the program to able-bodied, working-age adults. Half the states had the Obamacare Medicaid expansion in effect during the first six months of 2014, and those states accounted for 94 percent (5.7 million) of the 6.1 million individuals added to the Medicaid rolls during the period.

In contrast, the states that did not adopt the expansion collectively added only 355,000 people to Medicaid, reflecting modest growth in the populations traditionally covered by Medicaid - poor children, low-income pregnant women and disabled adults.

Separately, the Obama administration reported in May that 8 million people picked a plan through the exchanges during open enrollment - a figure that does not include new Medicaid enrollees. In September, the administration revised that 8 million figure down to 7.3 million people who actually completed the transaction and paid their first month's premium.

Yet the enrollment data show that the number of people covered through private individual-market plans (both on and off the exchanges) actually increased by only 6.2 million - not by 8 million, or even 7.3 million.

As noted, employment-based coverage also declined by a net of 3.8 million individuals during the period. Assuming that most of those individuals got replacement coverage through the individual market, that brings the increase in private coverage down to just 2.4 million people.

What this means is that, of the individuals who obtained coverage through the new Obamacare exchanges, no more than 2.4 million were previously uninsured. The rest of the Obamacare exchange enrollments appear to have resulted from a substitution effect - meaning enrollment in new exchange plans by people who previously had coverage through either an individual-market or employer-group plan.

These data tell us two basic things about Obamacare's performance.

First, when it comes to covering the uninsured, Obamacare is so far mainly an expansion of Medicaid.

Second, the new government exchanges didn't enroll many people who were previously uninsured.

The problem with Obamacare mainly being a Medicaid expansion is that the new Medicaid enrollees are not the vulnerable poor - children and disabled adults - that the program was designed to serve. Rather, they are able-bodied, working-age adults who have low incomes because they are either unemployed or under-employed.

Furthermore, 82 percent of the adults that qualify for the Obamacare Medicaid expansion don't even have dependent children. Giving those individuals Medicaid may increase the number of American's with health insurance coverage, but it doesn't provide them with what they need most: gainful employment.

Indeed, as the Congressional Budget Office has noted, expanding Medicaid to that population will actually discourage many of them from taking a job or working more hours if doing so means losing Medicaid coverage.

With respect to the new exchanges, the majority of enrollees apparently were people who already had coverage. It is also likely that many of them had to get new coverage because OC.