Fewer Poor Uninsured After Health Law, Study Finds

WASHINGTON — The share of poor Americans who were uninsured declined substantially in 2014, according to the first full year of federal data since the Affordable Care Act extended coverage to millions of Americans last year.

The drop was largely in line with earlier findings by private polling companies such as Gallup, but was significant because of its source — the National Health Interview Survey, a long-running federal survey considered to be a gold standard by researchers. The findings are being released on Tuesday.

The survey also registered a sharp decline in the share of black Americans who were uninsured, which fell by nearly a third to 13.5 percent from 18.9 percent in 2013. That was the largest annual change for any racial or ethnic group since the survey began in 1997.

The survey shows the impact the law has had as a far-reaching ruling on it by the Supreme Court nears. If the court rules against the government, it would have the effect of eliminating a large share of the subsidies that have enabled many lower-income people to afford health insurance.

The gains were particularly significant for poor Americans in part because a larger share of them lacked health insurance to begin with. But the poor also benefited from the subsidies, and from a vast expansion of Medicaid, the government insurance program for the poor. More than 20 states refused to expand the program, and many experts said the gains would have been even larger had they done so.

While black Americans under the age of 65 made the biggest gains, Hispanics in the same age group also benefited substantially, with the share of uninsured dropping by nearly 17 percent from 2013 to 25.2 percent. The share of whites who were uninsured fell to 9.8 percent, down from 12.1 percent in 2013.

“The law has had a more pronounced effect in covering African-Americans than whites,” said Larry Levitt, a director at the Program for the Study of Health Reform and Private Insurance at the Kaiser Family Foundation, a health research organization. He said part of the reason was that blacks were more likely to be poor, and the law specifically targeted poor Americans for help with coverage. “If all states were expanding Medicaid, you’d see an even bigger effect.”

Many of the states that declined to expand Medicaid were those with the highest share of their populations that were uninsured. They were also home to a large proportion of the country’s poor black residents. Low- and middle-income families above the poverty level are eligible for subsidies to pay for private insurance, but those below are not, and in states that did not expand Medicaid, they were left without coverage.

The share of uninsured among the poor and lower middle class, called “near poor” by the federal government, declined by 7 percentage points and 7.6 percentage points respectively, compared with a 2.5 percentage point decline for Americans who were not poor. The measure was for ages 18 to 64-year-olds.

In 2014, the federal poverty threshold was $23,850 for a family of four and $11,670 for a single person. Near poor was defined as those families living on incomes between 100 and 200 percent of poverty, or $23,850 to $47,700.

In all, about 32 percent of poor Americans were uninsured in 2014, down from 39 percent in 2013. The share of near poor Americans who were uninsured declined to 31 percent from 39 percent. The share of all other Americans who lacked health insurance declined to 9 percent from 11 percent.

The South had the highest share of uninsured people under 65, at 20.7 percent. The West had the second highest at 16.3 percent, followed by the Midwest, at 12.9 percent and the Northeast, at 11.2 percent. In all, the share of Americans of all ages who were uninsured was 11.5 percent in 2014, down from 14.4 percent in 2013.

In states that expanded Medicaid, the share of people under the age of 65 who were uninsured stood at 10.9 percent in 2014, down from 14.9 percent the year before. In states that did not expand, where uninsured rates were higher to begin with, the share dropped far less, to 16 percent from 18.4 percent in 2013.

Mr. Levitt said the law seemed to have had a greater effect on the long-term uninsured. The report found that the share of Americans uninsured for more than a year dropped to 9.7 percent from 12.4 percent, compared to a drop of about one percentage point for people who had been uninsured for just part of the past year.

The survey also included broader questions on health, but those did not change much from 2013.