The Patient Protection and Affordable Care Act (ACA) led to “dramatic improvements” in individuals’ ability to purchase health care insurance on their own, according to the Commonwealth Fund Biennial Health Insurance Survey for 2016. Most dramatically, adults with family incomes lower than $48,500 have experienced a 17 percentage point drop in uninsurance compared to the rates of uninsurance for those same individuals in 2010. The increase in coverage has also manifested as better care. The estimated number of adults, who reported difficulty accessing health care or filling needed prescriptions, fell by 17 million between 2012 and 2016.
Individual market. In the pre-ACA marketplace, the individual insurance market was not profitable for insurers, leading to large numbers of exclusions and other measures to reduce enrollees. The Commonwealth Fund estimated that in the three years prior to the passage of the ACA, one-third of individuals (9 million people) who tried to purchase insurance in the individual marketplace were turned down, charged more, or excluded from a plan.
ACA impact. The ACA turned the individual market around, nearly doubling its size and implementing now well-known consumer protections, including the ban on pre-existing condition exclusions. The Commonwealth Fund Biennial Health Insurance Survey examined the precise extent of the ACA’s impact.
Findings. In 2010, the number of uninsured U.S. adults ages 19 to 64 was 37 million. In July to November 2016, the number of uninsured adults in that category fell to 23 million. At the time of the survey, 147 million adults were insured continuously in 2016, which was up from a low of 129 million adults with continuous coverage in 2012. The most significant gains were experienced by individuals with low and moderate incomes. For example, adults with family incomes lower than $48,500, are uninsured at a rate 17 percentage points below the 2010 peak and 10 percentage points below 2001 levels.
Market reform. The survey found that reform of the individual marketplace made buying insurance easier because, prior to the ACA, individuals without employer-based insurance were presented with few affordable choices. Under ACA reforms, which went into effect in 2014, people with incomes between $24,000 and $97,000 for a family of four are eligible for premium tax credits, which help reduce premium obligations. It is because of subsidies like the premium tax credit, the Commonwealth fund determined, that the individual marketplace once again became a viable option for consumers.
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