There were several key takeaways from this week’s U.S. Census release about health insurance. Here are my favorites:
Things got better
There were over 700,000 fewer uninsured Texans in 2014 than in 2013 thanks to the Affordable Care Act (ACA). Texas’ overall (all ages) uninsured rate dropped from 22.1 percent in 2013 to 19.1 percent in 2014. Since 1999, Texas has never had a one-year improvement of even a single percentage point. These percentages reflect a drop from 5.7 million uninsured in 2013 to 5 million in 2014.
But Texas still has not only the worst percentage of uninsured, but also now the largest number of uninsured (passes up California)
Because California (with 38 million residents compared to Texas’ 26 million) had so many sign-ups both in private marketplace health care coverage and new Medicaid for working poor adults, the California uninsured rate dropped by 4.7 percentage points to 4.8 million. Texas now has the most uninsured by number and percentage.
Neighboring states with Medicaid expansion saw much larger improvements in their coverage rates
In our neighborhood, Arkansas’ uninsured rate improved from 16 percent to 11.8 percent; New Mexico improved from 18.6 percent to 14.5 percent. These both beat Texas’ improvement of 3 percent.
Only states with Medicaid expansion (or a coverage expansion waiver, like Arkansas) saw drops in uninsured rates of 4 percent and higher
Kentucky, Nevada, and West Virginia were the 2014 Medicaid expansion rock stars, with uninsured rates dropping by more than 5 percentage points.
The average decline in Medicaid expansion states was 3.1 percentage points, and in Coverage Gap states 2 points
In the states that have not yet expanded Medicaid or created a Medicaid “waiver” alternative for coverage, residents with below-poverty incomes are left with no Medicaid and ineligible for private Marketplace premium subsidies; these are the “Coverage Gap” states.
Hiding inside the average declines: among the Coverage Gap states, Texas, Florida, and Georgia all saw drops of 3 percentage points or more. In contrast, uninsured rates in 13 of the other Coverage Gap states dropped by less than 2 percentage points. Among Medicaid expansion states, three of the four states with modest uninsured rate drops of under 2 percentage points started with 2013 uninsured rates in the single digits (compared to Texas’ 22.1 percent); and the fourth (New Hampshire) started at 10.7 percent uninsured in 2013 (i.e., only about half Texas’ uninsured rate).
The story continues
Remember, these new data from the American Community Survey’s huge 3.5 million sample size are only for 2014, the nation’s first full year of new coverage under the ACA. More Texans have gained coverage in 2015, and the Census will report those gains next September. On September 17t much more data will become available from the ACS that will give us new information about coverage in our largest cities, and allow a deeper dive into factors like how race and ethnicity factor into Texas’ uninsured population. STAY TUNED!