July 19, 2016 | Rosemarie Day

Health Reform Matters

Health reform matters… to a lot of people.  Health reform means many things, but in the US, we have been focused on expanding coverage to the uninsured.  Since the passage of the Affordable Care Act (ACA) six years ago (and Massachusetts health reform ten years ago), a great deal of progress has been made, as recently summarized by the President and the New York Times.  The journey has been rough, both politically and operationally, but I think we should take a pause and look at the real bottom line:  are more people insured today than they were before health reform?

The answer is a resounding:  YES!

Nationally, the rate of uninsured has dropped dramatically since the ACA was passed in 2010, and especially since exchanges went live in 2013:

uninsured graph

Source: CDC National Health Interview Survey. Data is for all ages.

This means that 20 million more people have insurance coverage today than they did 6 years ago.1 That’s the same as the population of the state of New York(!).


The expansion in health insurance coverage took place in two main areas:

Picture4Public Exchanges


And importantly, a third area has not seen the drop in coverage that many feared would happen:

Picture6Employer Sponsored Insurance



Picture4Public Exchanges

Today there are over 11 million people enrolled in public exchanges, many of whom were previously uninsured.  This number has grown steadily since launch.

public enrollment graph

Note: 2014 data is effectuated (paid) enrollments through 9/30/14; 2015 data is through 9/30/15; and 2016 data is through 3/31/16.  Source: CMS



Most states (almost 2/3 of them) have expanded their Medicaid program through the ACA, there has been a net gain in coverage of 22 million since 2010.2,3 Total enrollment now stands at 72 million.3 If the remaining 1/3 of the states expanded their Medicaid program, enrollment would grow by approximately 4 million.4



Picture6Employer Sponsored Insurance

Many employers have not dropped insurance coverage, despite early predictions that they would.  In fact, some employers have essentially expanded coverage, through having more employees “take up” existing offers of coverage.  On balance, the share of employees with employer-sponsored insurance coverage today has remained essentially the same as it was three years ago.

esi graph

Source: Urban Institute Health Policy Center’s Health Reform Monitoring Survey, March 2016.



In sum, while much has been written about the problems of health reform, and improvements certainly still need to be made, there’s no question that millions of people are better off than they were when they didn’t have health insurance coverage. 20 million people, in fact.


Source Data:

1. Center for Disease Control and Prevention, 2016. Early Release of Selected Estimates Based on Data from the National Health Interview Survey, 2015 [cited 2016 July 19]

2. Kaiser Family Foundation, 2011. Medicaid Enrollment: June 2010 Data Snapshot [cited 2016 July 19]

3. Kaiser Family Foundation, 2016. Total Month Medicaid and CHIP Enrollment [cited 2016 July 19]

4. Executive Office of the President, 2015. Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid [cited 2016 July 19]