States that have embraced the federal healthcare law
are seeing significantly sharper reductions in the rate of individuals lacking health insurance than are states that are not implementing key provisions of the law, according to a Gallup survey
In the 21 states that have opted to expand Medicaid to individuals with incomes up to 138% of the federal poverty threshold and taken some steps to develop a state-specific insurance exchange
, the rate of uninsured individuals
dropped by 2.5 percentage points from 2013 to the first quarter of 2014. In states that failed to take both of those steps, the reduction was only 0.8 percentage points.
That difference further highlights discrepancies in insurance rates across the country. In states that have embraced the law, 13.6% of non-elderly adults lacked coverage in the first quarter of 2014, according to Gallup. By contrast, 17.9% of such individuals are uninsured in states that haven't expanded Medicaid
and taken steps to establish a state-based exchange.
Overall, Gallup has found a significant decrease in the rate of uninsured since the state and federal exchanges opened Oct. 1. The uninsured rate peaked at 18% in the third quarter of 2013, but dropped to 15.6% during the first quarter of 2014.
The initial open enrollment period under the Patient Protection and Affordable Care Act closed March 31. However, individuals who started the enrollment process through the federal exchange before that date were allowed until April 7 to finish their applications. They have until April 30 to pick a plan. Most state-based exchanges have allowed similar extensions.
In addition, there will still be special enrollment periods throughout the year for individuals who experience life-changing circumstances, such as getting divorced or losing a job. There also are exceptions for individuals who experienced significant hardships—such as hospitalization or a natural disaster—that made signing up by March 31 difficult.
Tracking the level of uninsured is an imprecise science. The New York Times reported Wednesday
that the U.S. Census Bureau has made significant changes to its methodology for tracking the rate of those lacking coverage in hopes of getting a more accurate reading. The Times report suggested that the changes would make it difficult to gauge the effect of the ACA on changes in the level of uninsured individuals. But as Vox pointed out
, because of a delay in the Census Bureau's tracking, the new methodology will be utilized to determine the insurance rate for 2013—the year prior to full implementation of Obamacare.
Gallup utilizes a simple question in its survey: “Do you have health insurance coverage?” The margin of sampling error for the 2013 survey results was 0.3 percentage points. For 2014 results, it was 0.6 percentage points.Follow Paul Demko on Twitter: @MHpdemko