Meet the 19.2 Million Who Gained Health Insurance Under the ACA

As Republicans in Congress prepare to make good on their promise to repeal Obamacare, new data provides a snapshot of the nearly 20 million people who gained health insurance under the landmark legislation.

Sometimes, numbers speak louder than words.

A report from the Robert Wood Johnson Foundation and the Urban Institute provides a granular look at the 19.2 million people who've gained health insurance coverage from 2010-2015 under the Patient Protection and Affordable Care Act.

For all its warts and pimples, Obamacare has reduced the number of uninsured Americans to historic lows, even in the 21 states that refused to expand their Medicaid programs, and which often did little or nothing to support health insurance marketplaces selling commercial plans within their jurisdictions.

The Urban Institute census comes just as a Republican-controlled Congress is preparing to repeal the ACA and replace it with some vaguely worded alternative that will take effect at some as-yet undetermined date.

The timing is not by accident.

"This is something that we began after the elections," says Anuj Gangopadhyaya, a research associate at the Urban Institute and a co-author of the study.

"We thought this would be a great moment to re-assess and talk about where the ACA coverage gains have been realized throughout this country. There isn't any spinning going here. These are the numbers. We just wanted to lay them out and see what the data tells us, and the data speaks for itself."

Before Obamacare is repealed, let's look at some of the key findings taken from the Urban Institute study:

• An estimated 19.2 million nonelderly people gained health insurance coverage from 2010 to 2015.

• Coverage gains were broad-based; the number of uninsured fell substantially among all Americans under age 65, for both men and women, and across subgroups based on race/ethnicity, levels of educational attainment, and states.

• An estimated 2.8 million children from birth to age 18 gained coverage, suggesting that coverage expansions under the ACA and other policy changes for children's coverage implemented from 2010 to 2015 reached children in families above the progress made by prior expansions targeting low-income children.

• The number of uninsured adults ages 19 to 34 declined by 8.7 million (42%), and the number of uninsured adults ages 35 to 54 declined by 5.6 million (33%). More than 2 million adults ages 55 to 64, who are at or approaching typical retirement ages, gained coverage from 2010 to 2015. Approximately 5 million women of childbearing age (19 to 44 years old) gained coverage from 2010 to 2015.

• Among those gaining coverage from 2010 to 2015, 8.2 million (43%) were non-Hispanic white, 2.8 million (15%) were non-Hispanic black, 6.2 million (32%) were Hispanic, and 2.0 million (10%) were other non-Hispanics.

• Americans in every state gained health insurance coverage. States that expanded Medicaid under the ACA saw larger percentage reductions in their number of uninsured residents than did states that chose to not expand Medicaid (45% compared with 29%). Nonetheless, 6.9 million people living in states that did not expand Medicaid gained health insurance.

• California's uninsured rate fell 53.4%, translating into 3.8 million people gaining coverage. More than 2.3 million people gaining coverage from 2010 to 2015 lived in the Midwestern states of Illinois, Michigan, Ohio, and Wisconsin, with uninsured rates declining between 38% and 49%.

• Florida and Texas, two non-expansion states, saw about 3.3 million people gain coverage as statewide uninsured rates fell 36% and 27%, respectively. 

A particularly ironic statistic finds that 87% of adults who gained coverage did not have a college degree, and that includes 6.2 million non-Hispanic whites, a demographic that soundly voted for Donald Trump, who made repealing Obamacare a central pillar of his campaign.

Repercussions of Low-Information Voters
"This is a low-educated group. That's across races and states but that was definitely something that stood out in terms of describing exactly who we are talking about here," Gangopadhyaya says.

The numbers of insured could have been even higher if more states had shown a willingness to compromise. "I don't think it's too much of a stretch to conclude from this that we would have seen even more improvements if the states were more in lockstep for the Medicaid provisions," Gangopadhyaya says.

"We saw nearly 3 million children getting coverage throughout the five years," he says. "That's amazing because most of the ACA provisions were targeted not for children but for non-elderly adults. It means there was some reach in the ACA beyond the Medicaid and CHIP programs that were already in place."

What's going to happen to these 19.2 million newly insured Americans when the ACA is repealed? Nobody really knows because it's not clear what would follow the ACA.

"If some of these provisions are lifted without adequate replacement provisions, it's fair to say, you are going to see a drop in coverage and an increase in non-insurance rates following such an action," Gangopadhyaya says.