ECONOMIC REPORT OF THE PRESIDENT

ecause of the ACA’s provision allowing young adults to remain on a parent’s
plan until age 26, an estimated 20 million adults have gained coverage
because of the ACA.
The ACA’s main coverage provisions have also driven further coverage
gains among children, which are not captured in the data from the
Gallup-Healthways Well-Being Index used by Uberoi, Finegold, and Gee
(2016). As illustrated in Figure 4-5 above, the uninsured rate among children
has seen another sharp decline as the ACA’s major coverage expansions have
taken effect, equivalent to an additional 1.2 million children gaining coverage.10
Combining the gains that began in 2014 with the gains in children’s
coverage from 2008 through 2013 that were discussed above, an additional
3.1 million children have coverage in 2016 because of the decline in the
uninsured rate among children since 2008.
Both the law’s Medicaid expansion and its reforms to the individual
health insurance market are contributing to this major expansion in health
insurance coverage. To illustrate this, Figure 4-8 reports the decline in the
uninsured rate from 2013 to 2015 by state in relation to that state’s uninsured
rate in 2013. While every state in the country has seen a decline in its uninsured
rate since 2013, states that have taken advantage of the law’s Medicaid
expansion have seen markedly larger declines, with the largest declines in
those states that both took up Medicaid and had high uninsured rates before
the ACA’s reforms took effect. However, even those states that have not
taken up Medicaid expansion have made considerable progress in reducing
the uninsured rate, indicating that the law’s reforms to the individual health
insurance market are also working to expand insurance coverage.
The pattern of coverage gains by income provides additional evidence
that the law’s reforms to the individual health insurance market are contributing
to coverage gains, alongside Medicaid expansion. In particular,
Figure 4-9 shows that the uninsured rate has declined markedly among
individuals with incomes above the Medicaid eligibility threshold of 138
percent of the FPL, and these declines are similar in proportional terms to
those for individuals with incomes below 138 percent of the FPL. Notably,
declines have been seen both for people with incomes between 138 percent
and 400 percent of the FPL, who are generally eligible for financial assistance
10 The 1.2 million figure cited here reflects coverage gains for individuals ages 0 to 17 from
2013 through the first half of 2016, as reported in the National Health Interview Survey.
The data reported in Figure 4-5 include individuals ages 0 to 18 because 18-year-olds are
considered children for Medicaid and CHIP eligibility purposes, making this the most
appropriate age range to examine when discussing CHIPRA. By contrast, 18-year-olds are
already included in the estimate reported by Uberoi, Finegold, and Gee (2016) regarding the
effects of the ACA, so including 18-year-olds in this estimate would double-count post-2013
gains for 18-year-olds.
Reforming the Health Care System | 213