Uninsured Rate Drops as Health Law Rolls Out

It may just be the start of a new trend. The uninsured rate dropped modestly this month as expanded coverage rolled out under President Barack Obama's health care law, a major survey released Thursday has found.

The Gallup-Healthways Well-Being Index found that the uninsured rate for U.S. adults dropped by 1.2 percentage points in January, to 16.1 percent. That would translate to roughly 2 million to 3 million people gaining coverage.

The closely-watched poll combines the scope and depth found in government surveys with the timeliness of media sampling. Pollsters interview 500 people a day, 350 days a year. The survey can be an early indicator of broad shifts in society. The health care results were based on more than 9,000 interviews, about nine times as many as in a standard national poll.

"The uninsured rate had been expected to come down as the Affordable Care Act was implemented," said Frank Newport, Gallup's editor-in-chief. "That would be the most reasonable hypothesis."

The biggest change was for unemployed people, a drop of 6.7 percentage points. That was followed by a 2.6 percentage-point decline for nonwhites. Traditionally both groups are far more likely to be uninsured than the population as a whole.

The survey found no appreciable change among young adults ages 18-34. Members of that coveted, low-cost demographic have been ambivalent about signing up so far.

Women saw a decline of 1.9 percentage points, about three times greater than the 0.6 percentage-point drop for men. Uninsured rates also fell all along the income ladder, with those making $36,000-$89,999 seeing the greatest drop, 1.8 percentage points.

Major elements of the health care law took effect with the new year. Virtually all Americans are now required to get covered or risk fines. Insurers can no longer turn away people with health problems. New state-based markets are offering taxpayer-subsidized insurance to middle-class households.

Medicaid sign-ups are also rising. That's partly because of a program expansion accepted by half the states and partly as a consequence of previously eligible but unenrolled people now forced to comply with the law's individual coverage mandate.

The White House called the poll good news. "It shows that the law is working," said David Simas, a senior adviser.

Nonetheless, Newport said it could take a calendar quarter - three months - to discern a full trend. Other factors could also be behind the shift, including an improving economy.

"It's a drop, but not extraordinary," said Newport. "The glass is half full for proponents of the Affordable Care Act because things are moving in the right direction. But the glass is half empty because things haven't moved much."

The office of Senate Minority Leader Mitch McConnell, R-Ky., pointed out that the adult uninsured rate is about the same now as when Obama took office in 2009. It has gone as high as 18.6 percent during his term.

Gallup's numbers are not comparable to various figures cited by the Obama administration, estimates that have ranged to more than 9 million people benefiting.

For starters, the administration's numbers include children as well as adults. They combine people buying coverage in the new insurance exchanges, Medicaid enrollees, and young adults who can stay on a parent's plan until they turn 26.

But the administration doesn't tease out those who were previously uninsured. Some of those signing up for new plans may have already had insurance; they either had to switch coverage because of the law or they found a better deal.

The law is projected to eventually drive the uninsured rate down to single digits among legal U.S. residents. But its rollout has been a wild ride for Obama and congressional Democrats who passed it against lockstep Republican opposition.

The federal enrollment website serving 26 states went down when it was launched Oct. 1, and it took two months to make needed fixes. Meanwhile, at least 4.7 million people had their existing individual policies canceled because those plans didn't meet the law's requirements. Republicans hoped "Obamacare" would implode.

The story still could take unexpected turns because open enrollment season doesn't end until March 31. While the technical problems with HealthCare.gov have largely been cleared up, insurers are still reporting glitches. And consumers getting familiar with the new plans are finding that some tightly restrict their choices of doctors and hospitals.

"Even in this very early period that included the problems with the website, we are seeing significant coverage improvements," said Ron Pollack, executive director of Families USA, a liberal advocacy group. "By the time the enrollment period ends, the improvements cited in this survey will be much larger."

The survey was based on telephone interviews from Jan. 2-19 with a random sample of 9,145 adults aged 18 and older in all 50 states and the District of Columbia. For results based on the total national sample, the margin of sampling error is plus or minus 1 percentage point, larger for subgroups.