ECONOMIC REPORT OF THE PRESIDENT

percent were denied coverage, charged more, or had exclusions placed on
their policy due to pre-existing conditions (Doty et al. 2009).
Insurers’ desire to discourage enrollment by individuals with significant
health care needs also led them to limit coverage in ways that undermined
enrollees’ access to care and financial security. For example, plans
offered on the individual market frequently excluded or charged a high premium
for services like maternity care, prescription drugs, and mental health
care (Whitmore et al. 2011). One study estimated that, in 2011, 62 percent
of individual market enrollees lacked coverage for maternity services, 34
percent lacked coverage for substance abuse services, 18 percent lacked
coverage for mental health services, and 9 percent lacked prescription drug
coverage (ASPE 2011). Individual market policies also frequently imposed
very high cost-sharing requirements or placed annual, lifetime, or other
limits on the amount they would cover. Half of individual market enrollees
were estimated to be in policies that covered less than 60 percent of their
total medical spending (Gabel et al. 2012). Similarly, an estimated 89 percent
of those purchasing individual health coverage had a lifetime limit on their
benefits (Musco and Sommers 2012).
Reforms to Expand Health Insurance Coverage
The Obama Administration has implemented a series of reforms
designed to overcome the barriers described above and ensure that all
Americans can access high-quality, affordable health insurance coverage.
This work began in February 2009 with the enactment of legislation
improving CHIP and continued with the enactment and implementation
of the ACA, which made broader reforms to the health insurance system
in the United States. These reforms, as well as the evidence that they have
dramatically expanded access to health insurance coverage, are described in
detail below.
Strengthening the Children’s Health Insurance Program
The Children’s Health Insurance Program (CHIP) was created in
1997 and provides financial support beyond what is available through the
existing Medicaid program to states wishing to cover additional low- and
moderate-income children. Research has found that CHIP was highly effective
in increasing insurance coverage among children and implies that CHIP
was likely the main reason that the uninsured rate among children declined
almost without interruption from the late 1990s through the mid-2000s, as
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