Policy & Research


Issue Brief: Uninsured Rate Drops Significantly After First Year of ACA Marketplace

57,000 Fewer Kansans Uninsured in 2014

By Sheena L. Smith, M.P.P., Robert F. St. Peter, M.D., | November 17, 2015

Issue Brief: Uninsured Rate Drops Significantly After First Year of ACA Marketplace

The Kansas Health Institute has released an issue brief entitled Uninsured Rate Drops Significantly After First Year of ACA Marketplace. The brief analyzes recently released health insurance coverage data from the U.S. Census Bureau’s American Community Survey (ACS). The data reflect changes in insurance coverage for 2014, which was the first full year of implementation of the major health insurance expansion provisions of the Affordable Care Act (ACA).

Key findings include:

  • In 2014, the uninsured rates dropped significantly in both Kansas (12.3 percent in 2013 vs. 10.2 percent in 2014) and the U.S. (14.5 percent in 2013 vs. 11.7 percent in 2014).
  • The increase in insurance coverage can be attributed to small increases in direct-purchase (likely through the health insurance marketplace), employment-based and public insurance.
  • Kansas no longer fares better than the nation as a whole for certain groups. Children and young adults in Kansas are no longer less likely to be uninsured than nationally. The gap between the uninsured rates of White, non-Hispanics and Black/African Americans in Kansas is higher than in any other state (7.6 percent compared to 17.4 percent, respectively).

In January 2014, the ACA expanded the availability of insurance coverage nationally through state and federal health insurance marketplaces. At that time, Americans with incomes between 100 and 400 percent of the federal poverty level ($11,670−$46,680 for individuals and $23,850−$95,400 for families of four in 2014) became eligible to receive premium tax credits to help them afford insurance coverage purchased on those marketplaces.

Medicaid expansion was the other major strategy of the ACA to decrease the number of uninsured Americans. Many states expanded their Medicaid programs, but Kansas and 25 other states did not.

The decrease in the national uninsured rate is outpacing the decrease in Kansas. The average decrease in the uninsured rate between 2013 and 2014 for Medicaid expansion states was 85.5 percent greater than non-expansion states (25.6 percent vs. 13.8 percent, respectively).

“Uninsured rates have decreased overall, but some groups made greater gains nationally than they did in Kansas,” said Sheena L. Smith, M.P.P., KHI analyst and primary author of the report. “The fact that Kansas now has the largest gap in insurance coverage between African Americans and White, non-Hispanics is concerning given that U.S. and Kansas rates have been comparable in recent years. States that do not expand Medicaid will need to address affordability and access to care through other policy approaches.”

The Kansas Health Institute supports effective policymaking through nonpartisan research, education and engagement. KHI believes evidence-based information, objective analysis and civil dialogue enable policy leaders to be champions for a healthier Kansas. Established in 1995 with a multiyear grant from the Kansas Health Foundation, KHI is a nonprofit, nonpartisan educational organization based in Topeka.