‘Obamacare’ in first test as safety net

In past recessions, the uninsured rate would surge. Now, for the first time, Americans are experiencing a recession with the Affordable Care Act in place.

The health law’s expansion of Medicaid and its offer of subsidized health plans have provided a new safety net for those who have lost their jobs and their health insurance.

The Affordable Care Act gave states the option to cover poor residents through Medicaid, and it offered tax credits to help lowand middle-income Americans buy health insurance. Since the coronavirus pandemic set off job losses this spring, enrollment in both programs has been growing. Experts say sign-ups would probably be higher still if not for Trump administration moves that included slashing the ACA’s advertising budget and declining to have an additional sign-up period when the pandemic hit.

State Medicaid enrollment, according to one report, had an 11 percent increase from February to September in the 36 states that have released data. Another paper, from Manatt Health, shows those gains concentrated in states that have participated in the health law’s Medicaid expansion, with an enrollment growth rate of 22.2 percent between February and November.

Sign-ups for plans in marketplaces run by the federal government are up 6.6 percent compared with last year, according to a new federal tally. It is the only year during the Trump administration when enrollment increased, and amounts to a half-million more people seeking coverage from the federal marketplace. The total is still down compared with 2016, the last year the Obama administration was running the program.

Final government estimates of the uninsured rate are months away, but at least one survey, from the research group the Commonwealth Fund, shows the share of Americans without coverage was holding steady through the spring. The Affordable Care Act is a crucial reason for that.

“We’ve seen both the important security that it provides and a lot of the remaining holes in the safety net cast into stark relief in this twin crisis of dire health need and economic recession,” said Kate Baicker, dean of the Harris School of Public Policy at the University of Chicago.

Charts based on an analysis of census data by Matt Bruenig, president of the People’s Policy Project, show how the overall health insurance landscape has changed since the Affordable Care Act took effect. In 2009, 16.7 percent of Americans lacked health insurance, and, for those of working age, the poorer you were, the more likely you were to fall in that category.

Medicaid enrollment among low-income Americans has since surged, particularly in states that expanded their programs, reducing the disparities. Enrollment in subsidized private coverage has also grown among those earning slightly more. As the population has aged, more people have also become eligible for another public program, Medicare. The 2020 chart shows survey results collected early in the year, so these numbers do not reflect the impact of the COVID recession.