April 1, 2014 Liz Borkowski, MPH 0Comment

Yesterday was the end of the first open enrollment period for people buying private health insurance plans on the federal and state-run health insurance exchanges. President Obama announced today that more than seven million people enrolled in private plans, helped by a surge of signups in the few days before the deadline. Many of these enrollees (those with incomes between 100% and 400% of the federal poverty level) were able to get subsidies to decrease their premium costs.

Severe technical problems plagued Healthcare.gov — the federally run site where residents of states not creating their own exchanges could enroll — during its first few months. (People who tried to enroll through the site but encountered technical difficulties will get an extension on the enrollment deadline.) Some state-run exchanges performed better, while others have struggled. Community health centers, local agencies, nonprofits, and others have been working hard to help people through the enrollment process.

People signing up for insurance through the health insurance exchanges weren’t just getting private coverage. In the states that have accepted the Medicaid expansion, legal residents with incomes of up to 133% of the federal poverty level have also been signing up for Medicaid through the exchanges and their state agencies. Kentucky, which established its own exchange and accepted the Medicaid expansion, signed up 360,000 residents, and roughly 80% qualified for Medicaid, reports Chris Kenning in The Courier-Journal. (The Washington Post’s Stephanie McCrummen wrote a terrific article about what gaining Medicaid coverage means for residents of Breathitt County, Kentucky.)

Total enrollment numbers are an important indicator, but another key statistic is the percentage of previously uninsured people who gained coverage thanks to the ACA. In the Los Angeles Times, Noam N. Levey highlights some key figures: around one-third of those buying coverage through exchanges were previously uninsured; the majority of the 9 million people buying plans directly from insurers didn’t have insurance before doing so; and 4.5 million previously uninsured people signed up for Medicaid coverage.

We still need to wait for specific numbers, but it’s fair to say that this is an important increase in US health-insurance coverage. It would be even larger if the 24 states that have not yet accepted the Medicaid expansion would sign on to the program. We’ll still have to watch enrollment and premium prices to see whether new enrollees maintain their coverage, premiums are stable, and enrollment keeps growing — and whether the newly insured are able to see healthcare providers when they need to.

While the numbers are important, it’s also worth remembering what insurance can mean to the people who now have it: Finally being able to see a doctor about the nagging cough, knee pain, or suspicious mole. Not fearing the moment when the medical receptionist asks about insurance. Not losing sleep worrying that a single accident or cancer diagnosis could mean bankruptcy. For millions of people, the ACA means they can spend less time worrying and more time looking after their health.

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