CDC: Reducing the rate of uninsured may have plateaued

Progress reducing uninsured rate threatens to stall

By Ricardo Alonso-Zaldivar
Associated Press, November 3, 2016

President Barack Obama's legacy health care law has reduced the number of Americans going without health insurance to historically low levels, but continued progress threatens to stall this year, according to a new government report.

The study released Thursday by the Centers for Disease Control and Prevention suggests the law may be reaching a limit to its effectiveness in a nation politically divided over the government's role in guaranteeing coverage.

The CDC said the number of uninsured people dipped by only 200,000 between 2015 and the first six months of this year, which it called "a nonsignificant difference." The findings come from the National Health Interview Survey, which has queried more than 48,000 people so far this year.

Since the health care law's big coverage expansion in 2014, millions have gained coverage each year. Now the pattern appears to be changing.

Experts say Obama's overhaul deserves most of the credit for 20 million Americans gaining coverage since 2014. But progress has been less and less each year, and now it's slowed to a crawl.

"It has got to be close to tapped out," said Dan Witters, director of a major private survey that also follows insurance trends, the Gallup-Healthways Well-Being Index.

The new survey offers a hint that the nation's historic coverage expansion may have actually gone into reverse during part of this year. An earlier CDC report covering just the first three months of this year found that the number of uninsured had been even lower, an estimated 27.3 million people — or a million fewer than the six-month figure in the latest report.

Another notable finding from Thursday's report is that the share of Americans in high-deductible health insurance plans keeps increasing. That may help explain widespread anxiety about affordability at a time when overall health care spending is growing at a moderate pace.

The CDC survey defines high-deductible coverage as insurance that requires patients to pay at least the first $1,300 of annual medical expenses for an individual plan, or $2,600 for a family. In the first six months of this year, 38.8 percent of persons under age 65 were in high-deductible plans, an increase from 36.7 percent in all of 2015, the survey found.

Employers started shifting workers and their families to high-deductible plans before Obama took office, and now that's becoming the norm. Many people are unhappy with the change, and some public-opinion experts say that helps explain the continued low ratings for Obama's health overhaul, even if it was not the cause.


Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–June 2016

By Emily P. Zammitti, M.P.H., Robin A. Cohen, Ph.D., and Michael E. Martinez, M.P.H., M.H.S.A.
National Center for Health Statistics, November 3, 2016

* In the first 6 months of 2016, 28.4 million (8.9%) persons of all ages were uninsured at the time of interview — 20.2 million fewer persons than in 2010, but only 0.2 million fewer persons than in 2015 (a nonsignificant difference).

* Among adults aged 18–64, the percentage with private coverage through the Health Insurance Marketplace or state-based exchanges has not changed significantly — from 4.8% (9.3 million) in the second quarter of 2015 to 4.8% (9.4 million) in the second quarter of 2016.



By Don McCanne, M.D.

It looks like the reduction in the rate of uninsured as a result of the Affordable Care Act may have plateaued. This is not a surprise since it was understood that the design limitations of building on the existing fragmented financing system could never result in truly universal coverage.

A well designed single payer system would have accomplished the goal of universality. We could still reach that goal without increasing our total national health expenditures beyond the current level, not to mention that we would gain the multitude of other benefits of a single payer system.

The Cubs fans stuck with a perpetual loser for over a century, and they finally broke through last night. With the same determination, maybe we could finally achieve the political breakthrough that we need to enact a health care system that actually does include everyone. Next Tuesday could be a start.