Medicaid expansion, state exchanges bring down uninsured numbers

August 8, 2014

States actively embracing two key provisions of the Affordable Care Act show steepest declines in those without insurance.

If you practice in a state that has expanded Medicaid eligibility and established its own healthcare insurance exchange, chances are you’re seeing fewer uninsured patients than you were at the start of 2014.

A new survey of the nation’s uninsured finds that the states showing the largest drops in their number of uninsured residents have established their own exchanges rather than using the federal one, and have raised the income level at which adults qualify for Medicaid-both options made available under the Affordable Care Act. The survey was conducted by Gallup-Healthways as part of its “Well-Being Index.”

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Arkansas saw the biggest decline in the percentage of uninsured residents, from 22.5% to 12.4%, followed by Kentucky, which went from 20.4% to 11.9%, and Delaware, which fell from 10.5% to 3.3%. Rounding out the top 10 were Washington, Colorado, West Virginia, Oregon, California, New Mexico and Connecticut.

Dan WittersThe uninsured rate among the 21 states that both expanded Medicaid eligibility and established their own exchanges dropped from 16.1% to 12.1%. That compares with a decline from 18.7% to 16.5% among the 29 states that did one or the other, or neither.

“The already notable gap between the two groups of states widened through the first quarter to 4.3 points, as states that have implemented these core mechanisms of the Affordable Care Act reduced their uninsured rates three times more than states that did not implement these mechanisms,” the survey states.

Six states-Hawaii, Indiana, Michigan, Minnesota, Missouri and Pennsylvania-saw decreases of less than 1%, while Massachusetts and Utah saw no change in their rates of uninsured. (Hawaii and Massachusetts started with relatively low levels of 7.1% and 4.9%, respectively.) Iowa, Kansas and Virginia showed increases in their numbers of uninsured, but in numbers small enough to be "statistically insignificant," according to Dan Witters, research director for the Gallup-Healthways Well-Being Index survey.

The national uninsured rate in the second quarter of 2014 was 13.4%, compared with its peak of 18% during the last three months of 2013. That is the lowest quarterly rate in the more than six years since Gallup-Healthways began its Well-Being index.

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