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Uninsured rate drops faster in states that expanded Medicaid


By Paul Demko
Posted: July 29, 2014 - 6:45 pm ET
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Americans lacking insurance coverage are becoming more concentrated in states that have opted not to expand Medicaid, according to the latest survey data from the Urban Institute's Health Policy Center. Residents of southern states, Spanish-language speakers and high school dropouts are also a growing portion of the uninsured.

As of June, 60.4% of individuals lacking coverage lived in the 25 states that have opted not to expand Medicaid eligibility to residents with incomes up to 138% of the federal poverty level, as encouraged under the Patient Protection and Affordable Care Act. That's up from 49.7% in September of 2013, just before the first open enrollment period for the state and federal exchanges. The federal government will cover 100% of the cost for the first three years of expansion and 90% thereafter.

“They're leaving quite a bit of money on the table for their healthcare system,” Sharon Long, a senior fellow at the Health Policy Center, said during an event in Washington on Tuesday to discuss the findings.

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Southern states are disproportionately represented among those not opting to pursue Medicaid expansion. Arkansas and Kentucky are the outliers in the region. As a result, the share of the uninsured residing in southern states grew from 41.5% to 48.9% between September and June.

Overall, the uninsured rate dropped from 17.9% in the third quarter of 2013 to 13.9% in the second quarter of this year, according to the Urban Institute data. That represents a decrease of roughly 8 million in the number of adults under the age of 65 lacking coverage. The findings track recent survey results from Gallup, which showed the uninsured rate dropping from 17.1% to 13.4% since the fourth quarter of 2013.

For Medicaid expansion states, the uninsured rate among non-elderly adults dropped from 15.1% to 10.1%, according to the Urban Institute survey. But for non-expansion states, the decrease was just two percentage points, from 20.3% to 18.3%.

The growth among Spanish-language speakers and those lacking a high school diploma was less pronounced. The share of individuals lacking coverage who reported Spanish as their primary language grew from 17.0% to 19.9%. Similarly, the percentage of high school dropouts represented in the ranks of the uninsured increased from 23.8% to 28.1%.

Affordability was the most common reason cited by survey respondents for failing to obtain coverage, with 59.5% indicating that plans were cost prohibitive. By contrast, just 20.2% indicated that they didn't want coverage or preferred to pay the tax penalty for lacking insurance.

But lack of knowledge about the availability of subsidies may have led some people to wrongly conclude that they couldn't afford coverage. While nearly 60% of survey respondents indicated that they were familiar with the insurance exchanges and the individual mandate that are part of the federal healthcare law, just 38.2% expressed familiarity with federal subsidies that could offset premiums and out-of-pocket costs.

Stephen Zuckerman, co-director of the Health Policy Center, argued that signing up the uninsured will become more difficult in future open enrollment periods because those who really wanted coverage are now insured. “This is going to be a sales job,” Zuckerman said.

The Urban Institute's Health Reform Monitoring Survey has conducted quarterly online polls since prior to the launch of the state and federal exchanges. Each survey provides data on roughly 7,400 non-elderly adults and 2,400 children nationwide.

Follow Paul Demko on Twitter: @MHpdemko


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