Fewer Americans uninsured. Is Obamacare gaining momentum?

A government report provides new detail on the way President Obama’s Affordable Care Act has performed on its central goal: reducing the share of Americans who don’t have health insurance.

Some 13.1 percent of Americans were uninsured as of this year’s first quarter, down from 14.4 percent in same quarter of 2013, the National Center for Health Statistics reported based on a data for more than 27,000 Americans.

Although some other surveys come up with a different tally for the nation’s uninsured rate, what’s not disputed is that the law known as Obamacare brought that rate downward by nudging people to enroll in private plans or in an expanded Medicaid program.

After its near-disastrous rollout, Obamacare now appears to be gaining some momentum. The 2014 signup totals proved strong in the end. Attacks on the Affordable Care Act (ACA) aren’t proving to be the centerpiece of congressional Republicans' 2014 campaigns, as some pundits had expected. The press has been running stories with more positive headlines.

The broader debate about whether Obamacare is a success story continues, with both sides still sharply divided. Critics note that health care costs continue to rise for many Americans – a key challenge alongside the goal of expanding access to insurance.

But some ACA data points paint a more positive picture:

• The ranks of the uninsured are falling, according to a variety of surveys. From new Census Bureau numbers released Tuesday (which only go through 2013) to Gallup polls, they don’t converge on the precise share of Americans who lack coverage, but they see the share declining under the ACA. An Urban Institute survey finds that the share who are uninsured fell by a full percentage point during the second quarter of 2014 – after the survey by the National Center for Health Statistics was done.
• States that “opted in” to the law’s expansion of Medicaid have fared better in insurance coverage than those that declined to participate. The overall share of the population that is uninsured is almost twice as high in the opted-out states as in the opted-in ones, the Urban Institute finds. The gap is not just due to Medicaid itself, but also due to lower rates of private-sector insurance in those same states.
• Prices on Obamacare exchanges for next year aren’t skyrocketing. The packages offered can vary in price based on what city or county you live in, and what level coverage you choose. But a Kaiser Family Foundation review of benchmark plans found insurers filing rate plans that are little changed in major cities such as Los Angeles, New York, Baltimore, and Richmond, Va. Some such as Denver show a substantial price decline.

It’s important to take the pricing data with caveats attached. Health care experts say insurers may feel an incentive to hold their prices down during the early years of the ACA exchanges, in an effort to grab as big a share as they can of this emerging marketplace.

Many of those experts also warn that health insurance costs, after a period of relatively modest annual rises, could accelerate again in coming years. Most Americans get insurance from an employer-sponsored plan (rather than on the Obamacare exchanges). Employer-based plans saw average premium hikes of 3 percent this year for families, according to annual survey by the Kaiser Family Foundation.

During the past decade, employer premiums have surged by 69 percent for family coverage – with the share of those premiums paid directly by employees rising at an even faster rate.

That trend doesn’t mean Obamacare is failing. It was never crafted as a panacea for medical inflation. And many health care experts credit the law with some cost-control provisions that are helping at the margins, even as critics say other provisions in the law push costs up.

Beyond the law itself, though, the challenge of cost pressures in the industry remains. That backdrop – a problem still unsolved – may help explain why Obamacare remains unpopular with so many Americans, even though polls have found public support for central provisions in the law (like guaranteed access to insurance regardless of one’s health condition).

In a recent Kaiser poll, 47 percent of Americans said they view the law unfavorably – a bit higher than the typical negative rating for the law since its 2010 passage. One-third of Democrats and 49 percent of political independents take an unfavorable view.

So, if the tone of discourse about the ACA has tilted a bit in favor of Obama and his congressional allies, the Kaiser poll suggests it’s still not an issue that necessarily works to Democrats’ favor in the coming election.