Monitoring Coverage Changes in Early 2014: New Information from the Health Reform Monitoring Survey

Through a combination of broader Medicaid eligibility, an individual mandate, the development of health insurance marketplaces (exchanges), and the provision of subsidies to help low and moderate income individuals afford marketplace coverage, the Affordable Care Act (ACA) is projected to substantially reduce the number of uninsured Americans over the next several years. Although policymakers, stakeholders, researchers and the media all will be demanding information on the effects of the ACA’s coverage expansions as they roll out in January 2014, early information will be difficult to obtain given the lags in the availability of national data.

This paper will present findings from the Health Reform Monitoring Survey (HRMS) on how health insurance coverage is changing in the first quarter of 2014.  Separate estimates will be presented for adults in different age, income and state groups (e.g., with and without state Medicaid expansions, states with and without state-operated exchanges) to track change for key subgroups that may be affected differently by the policy changes being introduced under the ACA.  The Health Reform Monitoring Survey (HRMS) was launched in 2013 to provide a mechanism for timely information on the Affordable Care Act during the period before national survey data for 2013 and 2014 will be available.  We will report on both simple trends over time and regression-adjusted analyses that control for individual and family characteristics.

Based on a nationally-representative probability-based internet panel, the HRMS provides quarterly data for approximately 7,400 non-elderly adults and 2,400 children on insurance coverage, access to health care and health care affordability, along with special topics of relevance to current policy and program issues in each quarter.

The HRMS is fielded in English and Spanish with sample of nonelderly adults from KnowledgePanel®, a probability-based internet panel which provides laptops and internet access for free to households without internet access to ensure that those households are included in the panel. The sample is designed to produce separate estimates for different income groups and state groups with respect to ACA implementation.  Analysis of HRMS data collected in 2013 found that they track well with estimates from more established sources such as the American Community Survey and the National Health Interview Survey.  For example, patterns of uninsurance were similar overall and with respect to important factors such as age, income, and race/ethnicity and large gaps were also found between the insured and the uninsured in terms of access and affordability measures. 

     Based on findings from HRMS survey questions fielded in 2013 on awareness of the changes in coverage options under the ACA and experiences with Medicaid and the exchanges, we expect a significant bump in enrollment in 2014, with wide variation across the populations targeted by Medicaid and the exchange.  Early findings show significant variation in awareness and understanding of the ACA changes, and in preparedness for making health insurance decisions.  Similar questions will be asked in early 2014 as well, providing additional richness to our profiles of changes in insurance coverage in early 2014 under the ACA.