The latest data on Obamacare in Philadelphia: minimal impact so far

For the country as a whole, the Affordable Care Act has been successful at decreasing the number of uninsured Americans to a seven-year low. However, according to a recent authoritative survey, the decrease has been much lower in southeastern Pennsylvania.

The survey is the Southeastern Pennsylvania Household Health Survey conducted by the nonprofit Public Health Management Corporation. It is the longest running regional survey in the country, have started in 1983, and the most comprehensive in southeastern Pennsylvania. The results represent the experiences of 10,000 randomly selected households in Bucks, Chester, Delaware, Montgomery and Philadelphia Counties.

I recently spoke with Francine Axler, director of the 2015 survey, for an explanation of the most recent findings.

The survey revealed slight changes over the last ten years in the percentage of adults in southeastern Pennsylvania who are insured. Montgomery County had the highest percentage of adults between the ages of 18 and 64 with insurance at 96.3%, a 0.5% increase from 2006, followed by Bucks County with 95.4% (+1.1%), Chester County with 94.5% (-1.3%), and Delaware County with 94.3% (+0.3%). In last place was Philadelphia County with 89.9% (and the largest increase - 1.9%).

Across the region, the survey continued to find that Latino adults are more likely to be uninsured, followed by African-American adults. Males continue to be more likely to be uninsured than females.

More than 520,000 adults in southeastern Pennsylvania under the age of 65 looked into buying insurance on the ACA exchange, healthcare.gov, in 2015. More than one-third of them found it difficult to find a plan with a monthly premium or annual deductible they could afford.

Bucks County had the highest percentage of adults (42.4%) who found it difficult to find an affordable plan, followed by Montgomery County (40.4%), Delaware County (38.4%), Chester County (35.8%), and Philadelphia County (32.9%). Within each county, there was one region in which more than 50% of respondents found it difficult to find an affordable plan.

Among uninsured adults, 38% in Philadelphia County did enroll in an insurance plan through healthcare.gov, followed by 37.4% in Delaware County, 36.9% in Chester County, 35% in Bucks County, and 32.4% in Montgomery County.

The bottom line is that cost continues to be the primary reason that individuals go without health insurance.

It is still too early to measure whether the ACA had a significant impact on actual health outcomes. In the meantime, an important question to consider is whether individuals insured by the ACA are obtaining meaningful access to care.

To address this question, the survey looked at several basic measures of access to care, including whether the respondent had seen a doctor in the past year and whether he or she had utilized preventive screenings. The results showed that individuals covered through the ACA are less likely to have seen a doctor in the past year and less likely to have had routine health screenings than adults insured another way.

The clear implication is that many people need additional help affording the cost of insurance premiums and annual deductibles.

PHMC's next Household Health Survey of southeastern Pennsylvania will continue to measure the impact of the ACA by assessing changes in health care and service utilization patterns over time. Hopefully, this will help to drive policy to better meet the needs of at-risk populations in our region.

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