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.
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