Five takeaways from Gallup’s poll on the uninsured

HHS Secretary Kathleen Sebelius will likely tout the Gallup poll when she testifies this week. (Photo by Andrew Harrer/Bloomberg)
HHS Secretary Kathleen Sebelius will likely tout the Gallup poll when she testifies this week. (Photo by Andrew Harrer/Bloomberg)

Five months into the health care law's roll out, the rate of uninsured Americans has dropped to the lowest point since 2008, a new Gallup-Healthways Well-Being Index poll finds this morning. The survey is notable because the Obama administration says it doesn't even know how many uninsured people are signing up for Obamacare health plans.

The big headline from the report: 15.9 percent of adults are now uninsured, down from 17.1 percent at the end of 2013.

It's news that the Obama administration and the law's supporters are going to cheer as proof that the Affordable Care Act is working, and you'll likely hear a lot about it this week. HHS Secretary Kathleen Sebelius will testify on Capitol Hill twice, and the administration is expected to release another monthly Obamacare enrollment report.

Here are five things to know about the Gallup poll:

1. Young people are getting covered

The uninsured rate for the highly scrutinized 18-34 year-old demographic is dropping, but not yet to the levels the administration hopes for. The uninsured rate among 18-25 year-olds is now 23 percent, down from 23.5 percent, and the rate for 26 to 34 year-olds dropped from 28.2 percent to 26.6 percent.

Young adults, however, make up about 25 percent of exchange signups, according to the administration's most recent enrollment report from almost a month ago. It showed that young adults were signing up for insurance at a faster rate from previous months, but the administration had originally aimed for young adults to make up about 40 percent of exchange enrollees.With just three weeks left until the March 31 enrollment deadline, the White House this week is reaching out to moms to get their young adult children to sign up for coverage.

2. Hispanics are slow to sign up

Gallup found the uninsured rate has dropped across all major demographics, but Hispanics still have the highest uninsured rate of any group at 37.9 percent. It's down from 38.7 percent at the end of 2013, but the current uninsured rate is still far higher than that of black Americans (18.3 percent) and white Americans (10.9).

Hispanics were thought to be prime beneficiaries of the health care law because of their high uninsured rate and younger population. There's been much written about how California has had disappointing Hispanic enrollment numbers, despite the state's emphasis on enrolling the demographic in exchange plans. Kaiser Health News just a few days ago offered a good look at some of the marketing mistakes the state made in early outreach efforts.

3. Medicaid enrollment ticks up

One of the toughest Obamacare numbers to pin down is just how many people have signed up for Medicaid because of the health care law. HHS says 8.9 million people have been determined eligible for Medicaid and the Children's Health Insurance Program since the start of October enrollment, but that number includes people who renewed coverage and those previously eligible who hadn't signed up.

The Gallup poll doesn't fully answer how many have signed up because of the law, but it shows that the rate of people who say they're primarily covered by Medicaid increased from 6.6 percent to 7.4 percent since the end of 2013. Gallup says the law's Medicaid expansion, adopted by about half the states, is likely driving the increase.

4. Rate of employer coverage drops

The rate of people who say they're covered by a current or former employer dropped from 45.5 percent to 43.4 percent from the end of 2013. Meanwhile, the rate of people who say they're covered by a plan paid for by themselves or a family member increased from 17.2 percent to 18.1 percent over the same time.

The Gallup poll doesn't offer any explanation of the drop in employer-based coverage, but Kaiser Family Foundation insurance expert Larry Levitt cautions against reading too much into the numbers. He writes to me:

One needs to be careful in over-interpreting Gallup’s results, especially at the sub-group level, given the statistical volatility. The margin of error is plus or minus 1% among all adults, and even higher for sub-groups. So, it’s very likely that the change in employer coverage from the end of 2013 to the beginning of 2014 is within the margin of error.

Like other larger surveys, Gallup has shown a decline in employer coverage over time, driven by changes in the economy, not the Affordable Care Act.

As other sources of coverage grow this year – like Medicaid and the exchanges – employer coverage will decline as a share of insurance, but not necessarily in raw numbers. In the long-term, the Congressional Budget Office does expect employer coverage to decline as people have other options.

5. People with lower incomes signing up at faster rate

The uninsured rate among people earning less than $36,000 dropped 2.8 percentage points since the end of 2013, though their uninsured rate remains high at 27.9 percent. The uninsured rate for people earning between $36,000 and $90,000 is 10.8 percent, and the uninsured rate for people making more than $90,000 is 5 percent – both of those groups saw their uninsured rate drop .8 percentage points.

It's not surprising that lower-income people have had the largest drop in the uninsured rate. The group includes people who are signing up for Medicaid at no or very little cost, as well as those receiving the most generous subsidies for private plans on Obamacare exchanges. According to the most recent HHS enrollment report, about four in five people signing up on the exchanges are receiving financial assistance.

Jason Millman covers all things health policy, with a focus on Obamacare implementation. He previously covered health policy for Politico.
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