Obamacare Year One: Is the number of uninsured people lower?


The number of uninsured Americans has dropped about 25% in the first year of the Affordable Care Act (ACA), according to government reports and private surveys. In other words – or rather numbers – the amount of Americans without insurance has decreased something like 8 to 11 million people. Additionally, 3-4 million people – mainly young adults – acquired insurance through provisions of the law that became effective before this year. “There’s no question it (the uninsured rate)’s come down,” research director of the Gallup-Healthways Well-Being Index Dan Witters said. Gallup and three other research companies – as well as the CDC – confirmed the reduction.

Percentage of uninsured Americans




Rand Corporation



Commonwealth Fund






Urban Institute







The ‘before’ numbers are for on or near the third quarter of 2013 and the ‘after’ numbers are for the first six months of 2014, except for the CDC which only covered the first three months of 2014. Still, the federal agency’s results are pretty much consistent with the rest of the studies and all point to a clear reduction in rate of uninsured people. Whether these numbers will stand closer scrutiny is another matter entirely. Large federal surveys are viewed as more dependable but take longer to compile than private surveys. Moreover, critics point out that some people may have gotten and lost coverage as a result of not paying monthly premiums, or that the plans they obtained covered too few primary care providers or involved out-of-pocket spending so high that having access to coverage was not worth it.

One thing is certain, though, and it’s that more people would have bought insurance had more states expanded Medicaid. All signs indicate that more than half newly insured people signed up for this social healthcare program, in particular in the states that choose to widen Medicaid eligibility to low-income residents. These states (including Arkansas, Kentucky, Delaware, Washington, Colorado, West Virginia, Oregon, California, New Mexico, Connecticut, Maryland, Nevada, and Rhode Island) recorded the largest reductions in uninsured populations, especially when compared to states that declined to expand Medicaid.  

Unfortunately, the Supreme Court made Medicaid expansion optional which, among other policy changes, prompted the Congressional Budget Office (CBO) to lower its projection of people getting insurance though the ACA by 2017 from 32 million to 26 million – putting the nation at least one third of the way toward that goal. On the other hand, the CBO expects about 30 million people to remain uninsured in the foreseeable future. Some may be illegal aliens excluded from coverage under the law, others may not afford it, and yet others may simply prefer to pay a fine than be forced to buy anything. In summary, Obamacare may never achieve universal coverage – then again something which by very definition is impossible – but to paraphrase Dr. Cox, the pursuit of perfection should be an endless endeavor. In that sense, the Affordable Care Act got off to a great start, and could get a welcome boost if more states expanded Medicaid during its second year.