President Obama's healthcare law has reduced the number of uninsured adults by 8 million to 11 million in its first year, according to three new studies, and the vast majority report satisfaction with their new health plans.
Each comes to a similar conclusion: Nationwide, roughly 1 in 4 people who were uninsured last fall now have received coverage, representing a significant first step toward Obamacare's goal of near-universal coverage.
"The findings suggest that the Affordable Care Act is beginning to achieve its central goal — reducing the number of Americans who are uninsured and improving access to healthcare," said Sara Collins, the lead researcher and a vice president at the Commonwealth Fund, a New York foundation that supports healthcare research.
The biggest expansion of coverage came in California, where the percentage without health insurance has been cut in half, from 22% a year ago to 11% by early June, the Commonwealth Fund survey indicated.
About 1.2 million people have enrolled and paid their initial premiums for private health plans through the state's insurance exchange, Covered California. Many other individuals bought policies outside the exchange.
An additional 2 million people have been deemed eligible for Medi-Cal, the state's Medicaid program for lower-income people. But that program continues to be plagued by a severe backlog of applications. At last count, state officials said, about 600,000 Californians were still awaiting word on their Medi-Cal eligibility and coverage.
California officials expect more detailed figures on the number of newly insured residents to be available this fall from a statewide survey.
Nationally, adults younger than 35 have accounted for the sharpest increases in coverage, according to both Commonwealth and Gallup data.
The Commonwealth study, based on a survey of nearly 4,500 American adults, also includes extensive data about consumer reactions to the new health plans.
The law has generated considerable consumer gripes about smaller provider networks and confusion over which doctors and hospitals are available. But the study found that more than three-quarters of those who had either enrolled in Medicaid or bought a private insurance plan in the new marketplaces reported that they were either "very" or "somewhat" satisfied with their new coverage.
More than half — 54% — also said that some or all of their preferred doctors were covered by their health plans, compared with 5% who said the plans did not cover the doctors they wanted. About 4 in 10 said they did not yet know.
About 6 in 10 said they had visited a doctor or hospital or filled a prescription using their new coverage. Nearly two-thirds of those people said they would not have been able to do that previously.
More than half — 58% — said they were better off with their new coverage, compared with 9% who reported they were worse off. About 1 in 4 said the new coverage had not had an effect one way or the other.
Although people who identified themselves as Democrats reported somewhat higher levels of satisfaction, roughly 3 out of 4 Republicans said they were also satisfied.
The figures from all three studies fall roughly in line with projections by the Congressional Budget Office. Based on the experience of previous government programs, the budget office projected that enrollment would continue to grow, further reducing the uninsured population.
But the new studies point to some significant hurdles.
Most notably, the biggest improvements in insurance coverage have taken place in the District of Columbia and the 25 states that have expanded their Medicaid programs.
That means the remaining uninsured Americans increasingly are concentrated in states that have declined to expand Medicaid — primarily Southern and Midwestern states with Republican-controlled governments that have been hostile to the new law and, in many cases, have tried to impede its implementation. That political resistance could be a major factor in holding down enrollments in the next couple of years.
Moreover, despite extensive outreach efforts and considerable news coverage over the last year, many people still report being unaware of the new insurance marketplaces the law created. Even more did not know that the law provides financial aid to help people buy coverage, the Commonwealth study found.
Ignorance of the law crops up most often among those living in or near poverty — the group for whom the law potentially provides the greatest benefits.
A year ago, before the law took effect, only about 1 in 3 American adults in a Commonwealth survey reported knowing about the law's new insurance marketplaces. By this spring, more than two-thirds were aware of them.
But among those whose incomes were poverty level or near poverty, nearly half remained unaware of the marketplaces, and only 43% were aware that the law provided financial assistance.
Among the three studies, Gallup, which has tracked the number of Americans reporting insurance coverage since 2008, reported the largest decline in the number of uninsured.
The firm's latest data, released Thursday, found that the share of American adults without insurance had dropped from 18% just before the new law took effect to 13.4% in the second quarter of this year, which translates to about 11 million newly insured people.
The Urban Institute, which began its own monitoring project last year, reported a smaller decline, of about 8 million adults, while the Commonwealth Fund estimated 9.5 million.
The Commonwealth Fund survey, conducted between April 9 and June 2, has a margin of sampling error of plus or minus 1.8 percentage points. The Gallup data comes from 45,125 interviews conducted between April 1 and June 30 and has a margin of sampling error of plus or minus 1 percentage point.