Glied Sherry, Ma Stephanie, Verbofsky Sarah
Robert F. Wagner Graduate School of Public Services, New York University, USA.
DaVita Kindney Care.
Issue Brief (Commonw Fund). 2016 Dec;44:1-12.
Issue: While the number of uninsured has decreased substantially since the Affordable Care Act (ACA) expanded coverage in 2014, questions remain about how much the economic recovery and other changes might have influenced this decline. Goal: Assess the direct impact of the ACA marketplaces and the Medicaid expansion on the uninsured rate among nonelderly adults. Methods: Analysis of insurance coverage rates before and after the ACA’s first open enrollment period (fall 2013 to spring 2014) using the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance Survey (BRFSS). Key findings: Based on NHIS data, enrollment in ACA-related coverage options explains about 76 percent of the 4-percentage-point decline in the uninsured rate during the first open enrollment period. Marketplace enrollments reduced the adult uninsured rate by an estimated 1.7 percentage points to 2.3 percentage points. The effects were substantially more pronounced among adults eligible for income-related subsidies. Medicaid expansions in participating states further reduced the uninsured rate by an estimated 0.76 points to 1.0 points. Conclusion: The great majority of nonelderly adults who enrolled during the first open enrollment period would likely not have held health coverage without the ACA expansions.
自《平价医疗法案》（ACA）在2014年扩大医保覆盖范围以来，未参保人数大幅下降，但经济复苏及其他变化对这一下降产生了多大影响，仍存在疑问。目标：评估ACA市场和医疗补助扩大对非老年成年人未参保率的直接影响。方法：利用国家健康访谈调查（NHIS）和行为风险因素监测调查（BRFSS），分析ACA首个开放注册期（2013年秋季至2014年春季）前后的保险覆盖率。主要发现：根据NHIS数据，在首个开放注册期内，未参保率下降了4个百分点，其中约76%可归因于参保了与ACA相关的保险计划。市场注册使成年未参保率估计降低了1.7个百分点至2.3个百分点。在符合收入相关补贴条件的成年人中，这种影响更为显著。参与计划的州扩大医疗补助，使未参保率进一步降低了约0.76个百分点至1.0个百分点。结论：如果没有ACA的扩大计划，在首个开放注册期参保的绝大多数非老年成年人可能无法获得医保覆盖。
