Hot off the press! Today we get our first look at annual insurance coverage data from the Centers for Disease Control (CDC) for 2014 and the results are in: fewer people were uninsured in 2014—the first year of full ACA implementation— than 2013. Children and adults in Medicaid expansion states had lower rates of uninsurance. In addition, after a period of stagnating uninsurance rates for children, 2014 shows some improvement in children’s coverage rates.

The new report, Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2014, highlights 2014 data from the National Health Interview Survey (NHIS). Data from the report provides new insight into the ways the ACA’s major provisions, notably Medicaid expansion and marketplaces, have impacted coverage rates. Uninsurance rates varied significantly between states based on their ACA implementation decisions, with much higher rates of uninsurance in states that did not extend eligibility to low-income adults under 138% of the FPL. More highlights below:

From 2013 to 2014, uninsurance rates for nonelderly adults (ages 18-64) and children (ages 0-17) dropped significantly.

• Nonelderly adults saw a 4.1 percentage point drop in their uninsured rate, from 20.4% in 2013 to 16.3% in 2014. Nearly 8 million adults gained coverage (39.6 million uninsured adults in 2013 to only 31.7 million in 2014).
• Children saw a 1-percentage point reduction in their uninsured rate, from 6.5% in 2013 to 5.5% in 2014. Nearly one million children gained coverage in 2014 (4.8 million uninsured children in 2013 to 4 million in 2014).

In general, Medicaid expansion states had lower rates of uninsurance and saw larger decreases in uninsurance rates. (Note that Medicaid expansion is defined as states moving forward with expansion as of October 31, 2013.) 

• In 2014, adults in Medicaid expansion states were less likely to be uninsured (13.3%) than nonexpansion states (19.6%). In Medicaid expansion states, the percentage of uninsured adults dropped 5 percentage points, from 18.4% in 2013 to 13.3% in 2014. In nonexpansion states, the adult uninsured rate dropped 3 percentage points, from 22.7% in 2013 to 19.6% in 2014.
• Of the 42 states with reported data, 16 states saw a significant decline in uninsurance rates of nonelderly adults from 2013 to 2014, the vast majority of which (12 states) expanded Medicaid.
• Children living in Medicaid expansion states were also less likely to be uninsured (4.3%) than nonexpansion states (6.7%). In Medicaid expansion states, the percentage of uninsured children dropped from 5.6% in 2013 to 4.3% in 2014. In nonexpansion states, the rate of uninsured children dropped from 7.5% in 2013 to 6.7% in 2014.

While children’s coverage increased, a look behind the curtain reveals additional opportunities for growth. Overall it’s great news to see gains in coverage for kids in 2014 compared to years past. But dig into the details, and we note some places to watch more closely. While the rate of children with private coverage increased (52.6% in 2013 to 53.7% in 2014), the rate of children with public coverage through Medicaid and CHIP remained constant (42.2% in both 2013 and 2014). In part, 700,000 children enrolling in Marketplace coverage could explain the increase in private coverage. The stagnating rates of public coverage suggests more work could be done to connect the lowest income children to public coverage, since we know the majority of uninsured children are already eligible but unenrolled. We also know there’s more to see under the hood when you look at public coverage for kids in 2014 based on state-specific experiences with renewals, transition to new income counting rules (MAGI), and consumer assistance.

This early snapshot of health insurance coverage trends provides a look into how the ACA has shaped children and families’ access to coverage. Other federal surveys with larger sample populations, particularly the American Community Survey (ACS) and the Current Population Survey (CPS) from the US Census, will offer more detailed state-by-state trend analysis. Stay tuned for our annual in-depth analysis of ACS data in the fall to report on how children are faring from state-to-state.