A recent Gallup poll shows that the percentage of uninsured Americans in some states has dropped dramatically since the federal Affordable Care Act (ACA). The drops are generally more dramatic in states that have embraced politically controversial portions of the law. In Kansas, which resisted those measures, the reduction in uninsured residents is small and within the poll's margin of error.
Seven of the 10 states with the biggest reductions in uninsured rates implemented Medicaid expansion and established a marketplace while two did one or the other, according to Gallup.
Kansas' uninsured rate ranked among rhe best in the nation before the ACA, but now other states that expanded Medicaid or built and promoted their own marketplace are catching up or surpassing it.
“In general, if we had the political will to do one or the other or preferably both, we would be in really good shape in terms of looking at our uninsured rate compared to other states, especially when you look at where we started,” said Sheldon Weisgrau director of the Health Reform Resource Project in Topeka.
States that both expanded Medicaid and set up their own marketplaces saw their uninsured rate drop from 16 percent in 2013 to 8.9 percent, according to Gallup, a 44 percent drop. States that implemented one or neither went from 18.7 percent to 13.4 percent, a 28 percent drop.
Arkansas and Kentucky saw the biggest reductions in their uninsured rates since the ACA took effect at the start of 2014, according to the survey. Arkansas’ plummeted from 22.5 percent to 9.1 percent. Kentucky’s fell from 20.4 percent to 9 percent.
Nationwide, the uninsured rate plunged from 17.3 percent in 2013 to 11.7 percent through the first half of this year.
The data, collected as part of the Gallup-Healthways Well-Being Index, are based on daily surveys conducted from January through June 2015 in which respondents were asked, “Do you have health insurance coverage?” The margin of error is 1 to 2 percentage points for most states except those with small populations, where it climbs to as much as 4 percent.
The national drop in the uninsured rate comes two years after the Affordable Care Act, commonly called Obamacare, took effect. The rate is the lowest since Gallup began keeping track in 2008.
“The ACA is not only about health insurance coverage, but that’s its primary focus and so, looking at the percentage of folks that are uninsured, it’s a great measure to see how well it’s doing. And clearly it’s carrying out its primary purpose,” Weisgrau said.
The survey is the first since the Supreme Court ruled last month that, under the ACA, premium subsidies are available in states that did not set up their own insurance exchanges, or marketplaces, as well as in states that did.
According to Gallup, the uninsured rate in Kansas dropped from 12.5 percent in 2013 to 11.3 percent in the first half of 2015.
Scott Brunner, a senior analyst from the Kansas Health Institute, the parent organization of the editorially independent KHI News Service, said those numbers must be viewed in the context of a poll with a margin of error of up to 4 percent.
"Since the reported change in Kansas is only 1.2 percentage points between 2013 and the first half of 2015, the survey results mean that there was no statistical difference in the rate of uninsurance," Brunner said. "That is still interesting since other states clearly showed reductions in the rate of insurance coverage especially in states that expanded Medicaid."
In neighboring Missouri, the uninsured rate dropped by almost four percentage points, which Washington University health economist Timothy McBride attributed to robust outreach efforts by charitable foundations in Kansas City and St. Louis. But Weisgrau said Missouri missed an opportunity to lower it even more by expanding Medicaid or establishing its own marketplace.
Expansion would make all adults with incomes up to 138 percent of the federal poverty level eligible. That translates into $16,105 in annual income for an individual and $32,913 for a family of four.
Pleas by health advocates and hospitals in Missouri and Kansas to expand Medicaid have fallen on deaf ears. Legislators in both states say they’re concerned about the costs of expansion. The federal government is paying for 100 percent of expansion through 2016 and no less than 90 percent after that.
Recent reports by the Robert Wood Johnson Foundation and the Kaiser Family Foundation concluded that expansion saves states money by allowing them to use federal funds instead of state dollars to provide health services to pregnant women, prison inmates, people with mental illness and disabilities, and others.
Dan Margolies, editor of the Heartland Health Monitor team, is based at KCUR