Earlier this month, a new report showed that the United States reached the lowest uninsured rate ever recorded, according to the Department of Health and Human Services (HHS). This was the result of Democrat persistence of the last decade: the passage of the Affordable Care Act (ACA), the subsequent Medicaid expansions, the additional subsidies for ACA plans passed under Biden, and because throughout the pandemic, people have kept their Medicaid coverage.
In 2009, before the ACA was passed, roughly 50.7 million people, 16.7% of population, were uninsured. Today, despite narrow majorities and Republican opposition, the uninsured rate is half that. Since the passage of the ACA, 38 states and the District of Columbia expanded their Medicaid programs to cover people up to 138% of the federal poverty level. During the pandemic, in exchange for increased funds from the federal government, states were asked not to disenroll people from Medicaid. As a result, more people have received coverage and kept it over the past 2.5 years.
Medicaid expansion improves access to health care, financial security, and health outcomes. The states that have expanded the program have lower uninsured rates, better hospital budgets, and lower mortality rates compared to states who haven’t.
While more people were receiving Medicaid coverage, President Biden and Congress pushed to enhance the subsidies for ACA plans for people in the individual market. The expanded subsidies were recently extended through 2025 by the Inflation Reduction Act, and will save the average enrollee $800 per year. This led to approximately 2 million additional enrollees in ACA plans, increasing it to its highest ever enrollment of 14.5 million people.
But there is evidence that these policies will continue to grow. More states are considering Medicaid expansion: The Supreme Court made Medicaid expansion optional more than a decade ago and the question of expansion has seemed to be stuck in the mud in recent years. But, there is evidence that some of the last holdouts are beginning to warm to the idea as some rural hospitals have struggled to survive. Expanding Medicaid in the 12 non-expansion states would bring health care coverage to 3.7 million people and reduce the already low uninsured rate by a third. The remaining uninsured are largely low-income families, undocumented workers, and people who churn between coverage options.
Lasting change is hard, and in the U.S. our system is designed to make large, systemic change nearly impossible. But when lawmakers can coalesce around a policy, and build on it with time, big transformative change is possible. The ACA started by plugging holes in our current system: it created a marketplace for people who don’t have coverage through work, expanded Medicaid, and tweaked some Medicare programs. In the years since, lawmakers have built on the success of those policies, and today we are seeing the fruits of those efforts.
The work isn’t done: The system still costs far too much and doesn’t deliver high quality results for everyone. But the groundwork has been laid and it’s important to note how far we’ve come.
