Extending medical insurance coverage has normally been associated with better health outcomes and health status of people in different populations. As a result, the United States Department of Health and Human Services (HHS), in an online brief today, stated that the 2014 implementation of key provisions of Affordable Care Act (ACA) or Obamacare has resulted in more insurance coverage for people with poorer health. Previously, these provisions were predominantly covering non-elderly adults with good health.

HHS has made several efforts and announcements this month to boost enrollment in Obamacare plans, as well as to increase the strength of the risk pool of the plans. Such efforts include the implementation of the fourth enrollment season for Obamacare, which will begin on November 1 this year and will end  on January 31, next year.

The agenda for boosting enrollment also includes programmes to reach young adults and other people, directly via mail, who made individual shared responsibility payments, commonly known as Obamacare tax penalties. The agenda will be targeting these tax penalty-paying individuals who have not purchased medical insurance this year.

Nearly 45% of the people who paid the tax penalty in 2014 were under the age of 35. This number was previously 30% in 2013.To improve this number, the key provisions of the Act, such as premium tax credits for the purchase of private insurance for low and middle-income adults and expanded Medicaid eligibility for individuals with incomes up to 138 % of the federal poverty line, took effect on January 1, 2014.

According to HHS, the Medical Expenditure Panel Survey has revealed that for non-elderly adults, people with poorer health have more health insurance coverage in 2014 compared to 2013. A previously significant difference seen in the coverage of people in poor and good health before 2014 is now gone.

Nearly one third of the adults who were previously uninsured in 2013 now have insurance regardless of their health status.

For any insurance program, the individual or the business receiving it has to pay a premium, which represents the money to be paid to the insurance company.  Premiums are estimated separately for each individual case. In this regard, a key component of Obamacare was the ‘No Discrimination’ reform. Health status, pre-existing conditions, duration of coverage, claims history, gender, occupation, industry and small employer size can no longer be used to increase premiums for those seeking insurance.

Additionally, household component data from Medical Expenditure Panel Survey has also shown that adults with good health are more prone to gain other private or public insurances than people in fair or poor health who are more likely to receive Medicaid coverage.

From 2012 to 2013 patients were more likely to lose their coverage due to poor health status than in 2013-2014, whence the likelihood of losing coverage was not dependent upon a person’s poor or good health.

Furthermore, in 2013-2014 people were more likely to receive an insurance plan if they had a need for it. Individuals, who were previously without insurance and had least one chronic health condition, were most likely to get Medicaid compared to people with no chronic conditions.

The information and data in the brief is only for participating states as Medicaid expansion is optional. The Supreme Court decision of 2012, gave the states autonomy to choose whether they wanted to expand Medicaid coverage or not.

26 states and the District of Columbia expanded their Medicaid programs till the end of 2014 with the  US being  the only developed country without universal health care for its citizens.

World Health Organization’s (WHO) 2013 World health report has estimated that nearly 150 million people worldwide experience a ‘catastrophic health event’ each year due to out-of-pocket payment for health care services. In the US, the number one reason behind filing for bankruptcy  is medical expenses.

To minimize this, the Patient Protection and Affordable Care Act (PPACA) was based on the idea of covering maximum number of citizens by providing subsidized health insurance to people.

“The bill I’m signing will set in motion reforms that generations of Americans have fought for” said Obama, as he signed the bill proposing a major healthcare system haul on March 23, 2010.

On the other hand, Paul Ryan, the US House of Representatives Speaker, in a long chain of Republican efforts against the Act, recently introduced the party’s healthcare proposal that would repeal Obamacare but keep some of its popular provisions.

“This law [Obamacare] cannot be fixed”, said Paul Ryan.

However, the Republican plan is low on details such as estimates of cost and does not indicate how many people would be covered by the plan compared to the Obamacare, which has 20 million adults under its coverage.

Paul Ryan’s plan includes providing tax credits to help people buy insurance, providing the ability to buy insurance across state lines and also to provide $25 million for state-controlled, high-risk pools to help the people left out of insurance coverage.