On Wednesday, the Census Bureau gave Obamacare some good news: the number of people without health insurance dropped to 10.4 percent in 2014, down from 13.3 percent in 2013.
Colorado may be doing even better. When the Affordable Care Act launched two years ago, about 1 in 7 of the state's residents, or 14 percent, were uninsured, according to the nonprofit, nonpartisan Colorado Health Institute. That figure is now 6.7 percent, according to the organization's latest data.
Marilyn Kruse, a substitute teacher in the Jefferson County school district west of Denver, is one of those who got insurance after the Affordable Care Act launched.
For seven years before that, she went without insurance because she couldn't get it through her job. She had been denied coverage because she had pre-existing medical conditions; coverage that she could buy was extremely expensive. All the while, she continued to have health problems: a hip that needed surgery, carpal tunnel, bunions and a slipped disk.
"I had the disk go out and I was confused and scared," Kruse said.
She was scared that she couldn't pay to treat or repair her back problems. So she mostly avoided going to the doctor. When she did, she paid thousands of dollars out of pocket.
Then health reform launched. Kruse qualified for tax credits through Colorado's health insurance exchange, so she could buy a plan that came to $55 a month. "That was a very exciting moment in my life," Kruse said.
The size of the drop in the number of uninsured people was a surprise, according to Amy Downs, senior director for policy and analysis at the Colorado Health Institute. "I don't think that anyone was expecting it to really go down this much," Downs said.
In 2013, nearly 750,000 Coloradans were uninsured. Obamacare cut those numbers in half, to a level that was once considered unreachable, says Downs. (The Census Bureau's data for Colorado show a less dramatic decrease. However, the Colorado Health Institute report was based on a survey performed in 2015, while the Census survey is from 2014.)
"We see a big growth in our Medicaid population that is much higher than we expected as well," Downs said.
Under the Affordable Care Act, the decision to expand Medicaid, the health plan for low-income Americans, was left up to the states. Colorado decided to expand. That's led the state to enroll about 450,000 people in the last two years. One in five Colorado residents is on Medicaid.
But the expansion in health coverage is tempered by rising concerns over cost and the number of people who are underinsured, which means out-of-pocket health costs are still too expensive.
The number of underinsured Medicaid enrollees in Colorado grew by more than 100,000 people since 2013, Downs said. "The increase in the underinsured really stood out for us."
An unaffordable out-of-pocket cost is defined in the Institute's survey as more than 10 percent or more of annual income. For those at 200 percent of the federal poverty level, any cost above 5 percent of income is considered unaffordable.
"People on Medicaid have really low incomes, so it doesn't take very much spending to get them into that underinsured category," said Downs.
Gwendolyn Funk, a 37-year-old who lives in Dove Creek in the southwest corner of Colorado, considers herself underinsured. "Well, I'm glad that I have insurance, it's just that I can barely afford my policy and my premiums, along with my children's," said Funk.
Funk's husband, a mechanical engineer, gets insurance through his employer. But it's too expensive for her and their two kids to get insurance through him. So they pay $500 a month to privately insure Funk and the children.
"We're going to have to choose between basically either eating or paying for health insurance," Funk said. "It's going to be really, really difficult."
Still, nearly 75 percent of Coloradans give the state's health care system a thumbs up, saying the current system meets the needs of their family.
AUDIE CORNISH, HOST:
The number of people with health insurance in the United States rose by 9 million in 2014. That's in a report out today from the Census Bureau. The Affordable Care Act is a major reason for the increase. We're going to go next to a state where the number of people without health insurance has fallen by half since the ACA was implemented. But as we hear from Colorado Public Radio's John Daley, paying for that coverage can still be a challenge.
JOHN DALEY, BYLINE: Marilyn Kruse shows off pictures of her four grandkids at her home in Wheat Ridge, Colo.
MARILYN KRUSE: Here's my two oldest grandkids that are...
DALEY: She's a substitute teacher and for seven years, went without insurance. Kruse tried to buy it on her own, but it was either too expensive or she was denied for pre-existing medical conditions. All the while, she continued to have health problems - a hip that needed surgery, carpal tunnel, bunions and a slipped disk.
KRUSE: I had the disk go out, and I was confused and scared.
DALEY: Scared she couldn't pay for it, so she mostly avoided going to the doctor. When she did, she paid out of pocket. Then the Affordable Care Act launched. Insurers couldn't deny her coverage, and with the help of tax credits, she got a plan on Colorado's health exchange for $55 a month.
KRUSE: Yes and I did (laughter). And that was a very exciting moment in my life.
DALEY: A new report from the Colorado Health Institute documents how many of the state's residents have similar stories. The Institute's Amy Downs says the uninsured rate has plunged from about 14 percent two years ago to just under 7 percent now.
AMY DOWNS: I don't think that anyone was expecting it to really go down this much.
DALEY: Today's census report shows steep declines in many other states as well, especially in states that expanded their Medicaid programs. In Colorado, the decline in the uninsured was once thought to be unreachable, says Downs.
DOWNS: We see a big growth in our Medicaid population. That is much higher than we expected as well.
DALEY: Under the ACA, people could get insurance through the exchanges and through Medicaid. The decision to expand Medicaid, the health plan for low-income Americans, was left up to the states. Colorado did expand, and now 1 in 5 residents is on it. But insurance coverage is not the whole picture. Downs says people are still struggling to pay for care.
DOWNS: The increase in the underinsured really stood out for us.
DALEY: You're considered underinsured if you have insurance but your out-of-pocket health care costs are more than you can afford. Downs says their survey shows a lot of people, especially those on Medicaid, have this problem.
DOWNS: People on Medicaid have really low incomes, so it doesn't take very much spending to get them into that underinsured category.
DALEY: And it affects people with private insurance too, like Gwendolyn Funk.
GWENDOLYN FUNK: Well, I'm glad that I have insurance. It's just that I can barely afford my policy and my premiums along with my children's.
DALEY: Funk is 37 and lives in Dove Creek in the southwest corner of Colorado. Her husband, a mechanical engineer, gets insurance through his employer, but it's too expensive for her and the two kids to get insurance through him, and they don't qualify for tax credits. So they pay $500 a month for a plan for her and the children. She worries about being able to afford it next year.
FUNK: We're going to have to choose between either basically either eating or paying for health insurance. I mean, it's going to be really, really difficult.
DALEY: Still, the new survey finds overall views on Colorado's health care system have improved since the ACA took effect. Nearly 75 percent give it a thumbs-up for their family. And now a majority thinks it meets the needs of Colorado in general. That's up sharply from four years ago. For NPR News, I'm John Daley in Denver.
CORNISH: This report is part of a partnership of NPR, Colorado Public Radio and Kaiser Health News. Transcript provided by NPR, Copyright NPR.