The percent of American who lack health insurance fell to 11.0% in the first quarter of 2016 according to a Gallup poll released this week. That's the lowest level the poll has ever recorded.

The rate stood at 11.9% as recently as the fourth quarter of 2015, so the drop is substantial. It most likely reflects sign-ups during the latest open enrollment period under the Affordable Care Act, which took place at the end of 2015.

The effect of the ACA on the falling uninsurance rate is hard to miss. In the fourth quarter of 2013, just before the ACA's insurance exchanges and coverage mandate went into effect, the rate was 17.1%. It has fallen since then by more than 35%.

More evidence of the ACA's effect is seen in the kinds of coverage that are growing most quickly. The largest growth has been in individual plans that people fully pay for themselves. This is the kind of plan that is sold on the exchanges. The next largest growth has been in Medicaid, which has been expanded under the ACA in 32 states.

The Gallup results showed a decline in uninsurance across all age groups. It also showed declines across racial groups, with the greatest drops among blacks and Hispanics.

In terms of numbers of newly insured, the federal Department of Health and Human Services estimates that 20 million people have gained coverage because of the ACA.

That's the glass half full perspective. But the glass can also be seen as half empty. The Census Bureau estimated that as of last November 33 million people still lacked coverage. This group was disproportionately poor, black and Hispanic.

Questions also persist over the nature of the coverage that many of the newly insured have gained. Many policies sold on the exchanges require patients to satisfy very high deductibles before coverage begins, and they limit reimbursement to services rendered by narrow networks of doctors and hospitals.

The ACA is still a long way from providing universal coverage. However, the falling rate of uninsurance suggests slow but steady progress toward that goal.


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