Survey: 9 in 10 US adults have health insurance

Underlining a change across the United States, nearly 9 out of 10 adults now say they have health insurance, according to an extensive survey released Monday.

The Gallup/Healthways survey found that the share of adults who lack insurance dropped to 11.9 percent for the first three months of 2015, the lowest level since that survey began tracking it in 2008. As recently as 2013, slightly more than 8 out of 10 adults had coverage.

Coverage gains from 2014 to 2015 translate to about 3.6 million fewer adults uninsured since the fall, before open enrollment got underway, according to Gallup.

The survey overlaps with the period when the second signup season under the Affordable Care Act (ACA) was winding down.

"The Affordable Care Act had three major objectives: increase coverage, slow the rate of increase in costs and improve health," Dan Witters, the research director for the poll, told the Associated Press. "The first one is clearly a win. Coverage is increasing. There is no question about it."

Although the economic recovery has likely contributed to coverage gains, the uninsured rate is now significantly lower than it was in early 2008, before the recession. That suggests that the gains in coverage are due to more than an improved economy.

"A big outstanding question is what will happen over the next couple of years," Larry Levitt, a health insurance expert with the nonpartisan Kaiser Family Foundation, told the AP. "To meet expectations, enrollment has to continue to grow and push the number of uninsured down."

On balance, an estimated 14.75 million adults have gained coverage since the fall of 2013, when the law's first open enrollment season was about to begin, according to Gallup.

Hispanics saw the biggest coverage gains of any ethnic or racial group, with an 8.3 percentage point drop in uninsured rates since the end of 2013. Even so, Hispanics are still more likely to be uninsured. "At a time when Republicans are very keenly trying to court the Hispanic vote, a large chunk of Hispanics are gaining insurance via the Affordable Care Act," Witters said.

Recent gains in coverage have benefited people up and down the income ladder. But the most notable improvement has been among those making less than $36,000 a year, a group that traditionally struggled to get and keep health insurance. Their uninsured rate dropped 8.7 percentage points since the end of 2013.

The Gallup/Healthways survey results were based on landline and cellphone interviews conducted from Jan. 2 to March 31 with a random sample of 43,575 adults age 18 or older.

The ACA — often referred to as “Obamacare” — offers access to private insurance for people who don't have job-based coverage, subsidies for households earning less than 400 percent of the federal poverty level and an expansion of Medicaid aimed at low-income adults in states that accept federal funding for it. Some states, including Florida and Texas, are among those refusing to expand Medicaid.

The law requires nearly every American to have coverage through an employer, a government program or a private plan. Those who are remain uninsured are charged fines, which increase each year, except for those who demonstrate financial hardship.

Comparing the most recent signup period with the first open enrollment season, Gallup/Healthways found that the uninsured rate declined at a slightly slower pace this time around. In the first three months of this year, the uninsured rate fell by 1 percentage point. Over the same period last year there was a 1.5 percentage point decline.

Whether the new data turns out to be a high-water mark for Obama's health care law or a milestone on the path toward his goal of getting virtually all U.S. residents covered remains to be seen.

The law's future is still up in the air and will turn on factors ranging from an upcoming Supreme Court decision on consumer subsidies to actions by Republican leaders in states opposed to Medicaid expansion.

Five years after its passage, the biggest question now for Obama's signature health care law is a legal challenge now at the Supreme Court.

At issue are four pivotal words in the law’s provision that stipulates subsidies be available to those buying from marketplaces, or exchanges, “established by the state.” If the law is read literally, approximately 7.5 million middle-income Americans could lose their insurance in states where the federal government has set up an exchange instead of the states. 

Opponents of the law argue that its language allows the government to subsidize premiums only in states that set up their own online insurance markets. Most have not done so and use the federal site, HealthCare.gov.

Supporters say that while some provisions may be confusing when read in isolation, the intent of Congress was to help consumers in every state pay their premiums.

An early reading of the judges’ questions suggests they are divided along ideological lines. A decision in the case is expected by late June.

Al Jazeera and The Associated Press