NCPA - National Center for Policy Analysis

Medicaid Expansion Increased Health Insurance Enrollment

October 23, 2015

Last year's changes in health insurance enrollment are of particular interest, as 2014 was the year in which key provisions of the Affordable Care Act (ACA, or Obamacare) took effect -- most notably, the offering of subsidies for coverage purchased through the new government exchanges and the ACA's Medicaid expansion.

The increased enrollment in individual-market plans in 2014 equates to 40.6 percent growth in a single year for that market segment. By comparison, during the previous three years, total enrollment in individual-market plans was nearly flat, fluctuating narrowly around 12 million individuals.

  • Enrollment in individual-market policies increased by almost 4.8 million individuals during 2014.
  • For the employer-group-coverage market, enrollment in fully insured plans dropped by 6.6 million individuals, while enrollment in self-insured plans increased by 2.1 million individuals.
  • The net increase in private health insurance in 2014 was just 260,000 people.

The nearly 9 million person increase during 2014 in enrollment in Medicaid and CHIP equated to single-year growth in those programs of 14.7 percent -- compared to the preceding three years' average annual growth rate of 2.3 percent. However, as noted, Medicaid enrollment growth during 2014 occurred disproportionately in states that adopted the ACA Medicaid expansion. In the states with the Medicaid expansion in effect, enrollment grew by 23.2 percent; while in the states without the expansion in effect, enrollment increased by 2.9 percent -- or just above the pre-ACA trend.

The growth in Medicaid enrollment over the course of the year occurred disproportionately in states with the ACA Medicaid expansion in effect. Indeed, the expansion states accounted for 92 percent of total Medicaid enrollment growth in 2014. When it comes to increasing the number of individuals with health insurance coverage, the net effect of the ACA in 2014 was almost entirely a simple expansion of Medicaid.

Source: Edmund F. Haislmaier, "2014 Health Insurance Enrollment: Increase Due Almost Entirely to Medicaid Expansion," Heritage Foundation, October 15, 2015.


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