Aaron: We missed a birthday for Healthcare Triage. On October first, we turned two years old. It's an easy day to remember for me because it's also my birthday, I'm a little older than two though.

October first 2013 was also the day that the Affordable Care Act (or ObamaCare's) insurance exchanges opened for the first time to pre-order insurance for January first 2014. So let's celebrate, or cry depending upon your political persuasion, with an update on the Affordable Care Act. This is Healthcare Triage News.

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Our first episode was "Open enrollment and ObamaCare," still one of our most popular episodes and pretty much all of the information in it is still relevant. Go watch it.

Let's start with the good news. The uninsured rate in the United States at the beginning of 2015 was 9.2%, that is 7 million fewer people than in 2014. That's also the first time the uninsured rate has been lower than 10% in no joke - forever.

In this nice chart made by Dan Diamond over at Forbes, with data from the national Health Interview Survey, you can see how since 2012, wen some of the regulations from ObamaCare went into effect, the number of uninsured has dropped steadily, dramatically in 2014 once exchanges kicked in.

Sure the rate of people on public insurance is higher today than it was a couple years ago, but you can see that the dramatic drop in the uninsured is accompanied by a mirrored uptick in private coverage. Now you can make an argument that the improving economy might be responsible for a decrease in the uninsured, and it's likely it has been to some extent, but to have the lowest percentage of uninsured ever? The economy isn't doing that well.

There are also differences in the uninsured rate depending on how well states are adopting the Affordable Care Act. In the states that have refused the Medicaid expansion, under age-65 uninsured rates dropped from 23% in 2013 to 17% in 2015, but in states that did expand Medicaid, the comparable uninsured rate dropped from 18.5% to 10.5%.

It is true that the Obama administration recently made news by announcing that the number of people expected to obtain insurance under the exchanges will fall short of previous projections. Specifically, they're now expecting about 10 million people to enroll in private exchange plans in 2016, compared to the 13 million that were previously thought might enroll not long ago. It's possible that the administration is lowering expectations, that way if they do better, they get to brag, and if things go bad, they've already done damage control early, but let's take them at their word.

Research shows that the number one reason people appear not to be buying plans is still the cost. Some can't afford them, and no Medicaid is available cuz no expansion. Others fall into the family glitch, where they can't get subsidies for family members because they have individual insurance from their jobs. And some can't afford insurance cuz even with subsidies, it's still too expensive, there's lots to fix about the insurance system.

But this could also be a problem with information dissemination. More than half of the people who didn't enroll because of the cost of insurance were eligible for subsidies, and it's not clear whether the subsidies were just inadequate, or whether they understood they were eligible at all. If the latter is the case then again, providing them help might improve the chance people might sign up for insurance plans. Doing so makes sense given how bad people are at choosing health plans in general.

Or they could watch Healthcare Triage! We're trying to help with the whole information dissemination thing. Seriously, go watch our episode again. And every October.

Healthcare Triage is supported in part by viewers like you through Patreon.com, a service that allows you to support the show through a monthly donation. Your support helps us make this bigger and better. We'd especially like to thank our research associate Cameron Alexander, and our first ever surgeon admiral Sam. Thanks Cameron! Thanks Sam! More information can be found at patreon.com/healthcaretriage.