New study looks at insurance coverage among families, finds the ACA has increased coverage

There is significant variation in health insurance coverage among families in the U.S., a new study finds, with women playing an increasing role in providing insurance coverage for their families.

The new report from the Employee Benefit Research Institute (EBRI) looks at health insurance coverage for U.S. families from 2012 to 2021. It finds that health insurance coverage has changed significantly over that time due to the implementation of the Affordable Care Act (ACA) and the changing role of women in the workforce.

Officials with EBRI say that health plan coverage differs within and across families, and that health plans are most similar within two-adult families without children and least similar within single-parent families.

“Over 70% of working adults are covered by a group health plan making it the predominant source of health insurance coverage. However, there is still substantial variation in health coverage within and across families in the United States. The [ACA] led to changes in the composition of health insurance coverage within families, by increasing access to group, non-group, and Medicaid coverage,” says Eden Volkov, Ph.D., the author of the EBRI report.

Both the ACA and changes in the labor market played a role

The study finds that increases in insurance coverage for families happened across the board during the time period studied, but the increase was higher when it came to Medicaid coverage, which was expanded in some states by the ACA.

“Following the 2014 Medicaid expansion, the share of families with children fully covered by Medicaid increased 50%, and the share of families without children fully covered by Medicaid increased by 33%. The 2016 employer mandate also led to increases in group coverage, but these were much smaller than the Medicaid expansion,” the study says. “Starting in 2017, the share of families with children fully covered by group health insurance increased 4%, and the share of families without children fully covered by group health insurance increased 5%.”

The study also notes how data on families and health insurance coverage has documented an increase in the number of women who are policyholders.

“Mothers are more likely to be the provider of group coverage for the whole family and are replacing fathers as the providers of family coverage,” the study says.  “On the other hand, group policy-holding rates have been steady for both childless men and women.” The report adds that an increase in rates of group policies among mothers can be explained by a rise in labor force participation and an “upscaling” of jobs. Women are also earning more over time, which reflects increasing entrance into higher paid occupations in the U.S.

The family glitch made a difference but is on the way out

The report also provides further evidence that the “family glitch” created by the ACA has made some families more likely to have members who lack health insurance. The ACA’s family glitch was infamous because language used in the law inadvertently created barriers to covering an employee’s family, even though the employee could access less expensive coverage.

The study notes statistics that show the family glitch had a measurable effect on coverage. “There is strong evidence that the ACA family glitch reduces the likelihood that partners are covered by non- group coverage, especially among families with children. Women whose partner has group coverage are 2–3 times more likely to be uninsured than have non-group coverage,” the report says.

Related: Biden administration announces finalized rule to fix “family glitch” in ACA

This glitch has caused much discussion over the past ten years, but the Biden Administration is implementing new regulatory language that will end the family glitch. In October, the IRS announced a final rule correcting the language of the law. In a statement, Biden notes that the change would happen in time for Americans to gain coverage through the open enrollment period this fall.

“The Treasury Department is finalizing that fix so that the law works the way Congress intended and the cost of coverage comes down for families all over the country,” Biden said on Oct. 11. “Starting next month, Americans can sign up to take advantage of this change. About 1 million Americans will either gain coverage or see their insurance become more affordable as a result of the new rule.”