Rates of Uninsured by State Before & After Obamacare

by John S Kiernan

Rates of Uninsured by State Before & After ObamacareHaving insurance is vital to the health of your family and your wallet.

We know rates of uninsured vary dramatically across states. Yet following the implementation of ACA/Obamacare, there’s been a lot of talk but not a lot of real information consumers can use to compare states by insurance coverage rates. Why? In part because we did not have a reliable estimate of what proportion of private health insurance enrollees under Obamacare were previously uninsured. Until now.

A recent study by the Kaiser Family Foundation (KFF) provides the best estimate to date of the proportion of private health plan enrollees under Obamacare who previously lacked health insurance and therefore would be gaining coverage under the new law. Based on their nationally representative survey of adults who purchase their own insurance, KFF finds that 57% of private plan enrollees were previously uninsured.

Combining this new data point with information on the number of new Medicaid recipients and private plan enrollees under Obamacare, WalletHub analysts are now able to offer an initial projection of uninsured rates post-Obamacare for 43 states and the District of Columbia.

Main Findings

 

Uninsured Rank

State Name

Uninsured Rate Pre-Obamacare

Projected Uninsured Rate Post-Obamacare

Difference Before and After

1 Massachusetts 4.35% 1.20% -3.16%
2 Rhode Island 14.34% 5.60% -8.73%
3 District of Columbia 9.09% 6.29% -2.80%
4 Hawaii 9.11% 6.35% -2.75%
5 Oregon 16.91% 6.38% -10.54%
6 West Virginia 17.34% 6.59% -10.74%
7 Minnesota 10.07% 6.61% -3.47%
8 Iowa 11.58% 7.47% -4.11%
9 Washington 16.01% 8.27% -7.73%
10 Kentucky 17.30% 8.95% -8.35%
11 Colorado 16.54% 9.02% -7.52%
12 Maryland 14.91% 9.13% -5.77%
13 Wisconsin 11.64% 9.75% -1.89%
14 New York 13.39% 10.16% -3.23%
15 Pennsylvania 13.27% 11.05% -2.22%
16 Ohio 15.19% 11.27% -3.92%
17 Virginia 14.91% 12.45% -2.46%
18 Tennessee 15.70% 12.46% -3.24%
19 Indiana 14.80% 12.78% -2.02%
20 Kansas 15.46% 12.91% -2.55%
21 Missouri 16.49% 12.95% -3.55%
22 New Jersey 16.83% 13.54% -3.29%
23 Utah 15.96% 13.57% -2.38%
24 Nebraska 14.71% 13.69% -1.02%
25 Arkansas 20.87% 13.77% -7.10%
26 South Carolina 19.25% 13.97% -5.28%
27 Illinois 16.16% 14.16% -2.01%
28 California 21.00% 14.26% -6.74%
29 Idaho 19.12% 14.41% -4.72%
30 South Dakota 15.88% 14.71% -1.17%
31 Alabama 15.97% 15.44% -0.53%
32 Arizona 20.13% 16.38% -3.74%
33 North Carolina 19.64% 16.68% -2.96%
34 Montana 21.98% 17.65% -4.34%
35 Georgia 21.66% 18.16% -3.50%
36 Wyoming 18.92% 18.29% -0.63%
37 Oklahoma 19.76% 18.33% -1.43%
38 Alaska 20.48% 18.96% -1.52%
39 Nevada 26.52% 19.58% -6.94%
40 New Mexico 24.29% 19.59% -4.69%
41 Florida 24.73% 19.61% -5.12%
42 Louisiana 22.41% 20.91% -1.50%
43 Mississippi 18.11% 21.46% 3.34%
44 Texas 26.80% 24.81% -1.99%
N/A Connecticut 9.50% N/A N/A
N/A Delaware 12.22% N/A N/A
N/A Maine 11.53% N/A N/A
N/A Michigan 13.46% N/A N/A
N/A New Hampshire 14.16% N/A N/A
N/A North Dakota 11.80% N/A N/A
N/A Vermont 9.28% N/A N/A
NATIONAL 17.87% 14.22% -3.66%

 

Average Uninsured Rate in States that Did and Did Not Expand Medicaid

 

Blue-States-Have-Fewer-Uninsured-Residents

Estimates Under Different Assumptions

There are several different estimates of the percentage of private health insurance enrollees who were previously uninsured. After reviewing the methodologies of these conflicting studies, we believe the Kaiser Family Foundation’s estimate—of 57%—to be the most accurate, given that it is based on a probabilistic, nationally representative sample and spans the appropriate time period. But what if, as some suggest, the proportion of private plan enrollees that were previously uninsured is actually much less than 57%? For example, an earlier study by RAND estimated that only 28% of new enrollees were previously uninsured; another study by McKinsey put the estimate at 36%. On the other hand, what if the proportion of new enrollees who were uninsured is actually higher—perhaps as high as 87% which the administration claims? How would the projected rates of uninsured change under these alternative scenarios?

National Uninsured Rate Under Different Assumptions

 

State Name

Uninsured Pre Obamacare

Projected Uninsured (RAND 28%)

Projected Uninsured (McKinsey 36%)

Projected Uninsured (Kaiser 57%)

Projected Uninsured (HHS 87%)

Alabama 15.97% 16.13% 15.94% 15.44% 14.73%
Alaska 20.48% 19.55% 19.39% 18.96% 18.35%
Arizona 20.13% 17.00% 16.83% 16.38% 15.75%
Arkansas 20.87% 14.29% 14.14% 13.77% 13.24%
California 21.00% 15.48% 15.15% 14.26% 12.99%
Colorado 16.54% 9.84% 9.61% 9.02% 8.18%
Connecticut 9.50% N/A N/A N/A N/A
Delaware 12.22% N/A N/A N/A N/A
District of Columbia 9.09% 6.85% 6.70% 6.29% 5.70%
Florida 24.73% 21.43% 20.93% 19.61% 17.72%
Georgia 21.66% 19.23% 18.94% 18.16% 17.05%
Hawaii 9.11% 6.57% 6.51% 6.35% 6.12%
Idaho 19.12% 16.04% 15.59% 14.41% 12.72%
Illinois 16.16% 14.73% 14.57% 14.16% 13.56%
Indiana 14.80% 13.49% 13.29% 12.78% 12.04%
Iowa 11.58% 7.80% 7.71% 7.47% 7.14%
Kansas 15.46% 13.60% 13.41% 12.91% 12.19%
Kentucky 17.30% 9.60% 9.42% 8.95% 8.29%
Louisiana 22.41% 21.67% 21.46% 20.91% 20.12%
Maine 11.53% N/A N/A N/A N/A
Maryland 14.91% 9.52% 9.41% 9.13% 8.73%
Massachusetts 4.35% 1.36% 1.32% 1.20% 1.03%
Michigan 13.46% N/A N/A N/A N/A
Minnesota 10.07% 6.91% 6.83% 6.61% 6.29%
Mississippi 18.11% 22.17% 21.97% 21.46% 20.72%
Missouri 16.49% 13.82% 13.58% 12.95% 12.04%
Montana 21.98% 18.95% 18.59% 17.65% 16.30%
Nebraska 14.71% 14.48% 14.26% 13.69% 12.88%
Nevada 26.52% 20.15% 19.99% 19.58% 19.00%
New Hampshire 14.16% N/A N/A N/A N/A
New Jersey 16.83% 14.17% 14.00% 13.54% 12.89%
New Mexico 24.29% 20.13% 19.98% 19.59% 19.04%
New York 13.39% 10.81% 10.63% 10.16% 9.49%
North Carolina 19.64% 17.96% 17.61% 16.68% 15.36%
North Dakota 11.80% N/A N/A N/A N/A
Ohio 15.19% 11.74% 11.61% 11.27% 10.79%
Oklahoma 19.76% 18.96% 18.79% 18.33% 17.69%
Oregon 16.91% 6.97% 6.81% 6.38% 5.76%
Pennsylvania 13.27% 11.91% 11.67% 11.05% 10.17%
Rhode Island 14.34% 6.55% 6.29% 5.60% 4.62%
South Carolina 19.25% 14.83% 14.59% 13.97% 13.08%
South Dakota 15.88% 15.25% 15.10% 14.71% 14.15%
Tennessee 15.70% 13.27% 13.04% 12.46% 11.62%
Texas 26.80% 25.74% 25.48% 24.81% 23.85%
Utah 15.96% 14.54% 14.27% 13.57% 12.58%
Vermont 9.28% N/A N/A N/A N/A
Virginia 14.91% 13.37% 13.12% 12.45% 11.51%
Washington 16.01% 9.07% 8.85% 8.27% 7.45%
West Virginia 17.34% 6.97% 6.87% 6.59% 6.21%
Wisconsin 11.64% 10.58% 10.35% 9.75% 8.89%
Wyoming 18.92% 18.99% 18.80% 18.29% 17.56%
NATIONAL 17.87% 15.08% 14.85% 14.22% 13.32%

 

State Comparisons

Uninsured_state_before_after_obamacare_070714-4

Ask the Experts

  1. To what extent is Obamacare succeeding in reducing the number of uninsured adults?
  2. Going forward, do you think the law will continue to reduce the number of uninsured adults? Will all Americans one day be covered?
  3. What do you think are the major obstacles facing Obamacare's implementation in the near term? In the long term?
  4. What do you think is the most common misconception people have about Obamacare?
< >
  • John Large Assistant Professor of Health Policy and Management at University of South Florida, College of Public Health
  • Kenneth E. Thorpe Robert W. Woodruff Professor and Chair of the Department of Health Policy & Management, in the Rollins School of Public Health of Emory University
  • Sean Nicholson Professor in the Department of Policy Analysis and Management at Cornell University, College of Human Ecology

John Large

Assistant Professor of Health Policy and Management at University of South Florida, College of Public Health
John Large
To what extent is Obamacare succeeding in reducing the number of uninsured adults?

That is a little difficult to answer definitively, at least to satisfy all people with opinions along the political spectrum. Part of the problem is that there are only two years to evaluate and, although only two points are needed to draw a line, it is not enough to qualify as a determination of a long-term trend. Another problem is that, though there are sources estimating the impact, there is no consensus on the actual amount of improvement.

The only thing that seems to be consistent is that the number of uninsureds has dropped, but with only 2 years of data, it is difficult to say that the total change is only due to the ACA. So, the only conclusion I can draw is that the ACA has had a positive impact in the drop of the number of adults not insured. More time and more studies are needed to confirm a more exact impact. However, it also appears that the rolls of the uninsured would increase by the repeal of the ACA.

Going forward, do you think the law will continue to reduce the number of uninsured adults? Will all Americans one day be covered?

Continuing with my sentiments from the first question, and assuming that no significant changes are made to the law, I am inclined to believe that the number of uninsured adults will continue to be reduced, but I am uncertain by how much over time and at what point there will be diminishing returns.

As the law stands now, even President Obama admits that the ACA as it exists today will not be enough to ensure coverage for everyone. More progressive work is required to help ensure coverage for all.

What do you think are the major obstacles facing Obamacare's implementation in the near term? In the long term?

The single greatest obstacle to either implementing or improving the ACA is the political opposition to the law. Indeed, there is a political philosophy that feels the government has no role to play in our lives, especially with subsidies. With that philosophy, the ACA will be at risk for repeal, let alone trying to improve it for more lives to be covered.

In the long-run, in my opinion, the best way to address the competing dilemmas of cost, access and quality in health care is to have a single-payer system, such as a “Medicare for all” type of model. The single-payer need not be run directly by the government, but could be privatized while being regulated to achieve certain outcomes. The ACA was a compromise to this model; since it took over 6 decades to come about, I do not expect to see this preferred system in my lifetime.

What do you think is the most common misconception people have about Obamacare?

There are plenty to choose from that seem to be bandied about. For example, people are opposed to anything that is not absolutely free market based. But many of these same people would not want to see Social Security or Medicare dissolved, so that view is inconsistent. Another argument is that the ACA will cause unemployment. However, no one talks about the freedom this will allow people to leave jobs that they feel trapped in merely because they have employer-based coverage. A third popular argument is that this law will skyrocket the federal deficit and debt. However, the consensus with the reputable studies disputes this argument and actually estimates that its repeal would cause this outcome.

Kenneth E. Thorpe

Robert W. Woodruff Professor and Chair of the Department of Health Policy & Management, in the Rollins School of Public Health of Emory University
Kenneth E. Thorpe
To what extent is Obamacare succeeding in reducing the number of uninsured adults?

The number of uninsured are approximately 16 million less today, compared to 2010, before the ACA started. There are still around 13-14% uninsured so a way to go yet. Fastest way to reduce would be to have states expand Medicaid to those under the poverty line.

Going forward, do you think the law will continue to reduce the number of uninsured adults? Will all Americans one day be covered?

Yes, as the financial penalties increase over time, the number of uninsured will continue to decline.

What do you think are the major obstacles facing Obamacare's implementation in the near term? In the long term?

Reforming how we prevent, deliver and pay for health care. We need a system that focuses on prevention, early detection and effective team based care coordination.

What do you think is the most common misconception people have about Obamacare?

That it is a government run system — it’s not. Individuals are purchasing private health insurance through competitive health insurance exchanges.

Sean Nicholson

Professor in the Department of Policy Analysis and Management at Cornell University, College of Human Ecology
Sean Nicholson
To what extent is Obamacare succeeding in reducing the number of uninsured adults?

The Affordable Care Act is succeeding as expected, in expanding insurance to those who do not have it. Before the ACA was implemented there were about 48 million people in the U.S. who were uninsured. The ACA was projected to cut this number in half, and after the first two years of the ACA program, about 12 million people have received insurance (either through the ACA exchanges or expanded Medicaid) because of it, which is what forecasters thought would happen. A study in JAMA this week reported that the uninsured rate among the non-elderly fell by 8 percentage points since the January 1, 2014 ACA rollout.

Going forward, do you think the law will continue to reduce the number of uninsured adults? Will all Americans one day be covered?

Yes, the ACA should continue to reduce the uninsured rate over the next 3-5 years, with another 12 million people expected to pick up coverage. This will happen as states decide to expand Medicaid (Alaska was the most recent state to agree to do so) and as lower-income people seek out and find a subsidized plan on the ACA exchange that they find acceptable. There is substantial political pressure on (mostly) Republican governors in states that have not expanded Medicaid yet to do so. We are not likely to see all Americans covered in the near future. This is because some lower-income people would rather not have insurance even when taxpayers are paying the majority of the price, and some higher-income people are not affected by the ACA subsidies and they prefer not to have health insurance rather than pay the associated fine.

What do you think are the major obstacles facing Obamacare's implementation in the near term? In the long term?

In the near term, the major threat would be if Republicans sweep the house, senate (with 60+ seats), and White House in 2016. If the ACA is popular at that point among the public, then it would still be safe from legislators because the fallout would be considerable if Republicans gut the ACA. But if the program is not popular, Republicans would dismantle it. In the long term, the threat is that health care costs return to their historical high growth rates and the public looks to politicians for measures to slow down spending. That is, if the ACA does not help slow down the growth rates, politicians could either modify the ACA or look for stronger tools to slow down spending. Or, the ACA is successful at slowing down costs (e.g., the Cadillac tax starts biting) but the public wants to have it all – great medical care without higher taxes.

What do you think is the most common misconception people have about Obamacare?

The most common misconception is that the ACA represents a government “takeover” of the health care system. We still have a health insurance system that is built primarily around employers offering employees private health insurance plans. The ACA has not undone this. Of the 12 million people who are insured because of the ACA, about half are in private health insurance plans. Medicaid is expanding, but many people who receive Medicaid are actually in health plans administered by private companies.

Methodology

We applied the following methodology to estimate uninsured rates for 43 states and the District of Columbia. Michigan and New Hampshire were excluded from the analysis because their Medicaid expansion did not go into effect until after the period analyzed here. North Dakota, Maine, Connecticut, Delaware & Vermont were excluded from the analysis due to data limitations. National projection is based only on those states for which we have complete data.

Due to data limitations, our analysis employs the following key scope conditions and assumptions:

  • We assume the rate of private plan enrollees who were previously uninsured does not vary by state.
  • We assume that all new Medicaid enrollees were previously uninsured and under the age of 64.
  • We assume that all individuals who selected a plan through the exchange paid their premiums and received coverage.
  • Our analysis is restricted to individuals under the age of 64.
  • We do not adjust the estimates of uninsured persons for any population changes or demographic shifts by state between 2012 and 2014.
  • We are not modeling the impact of other provisions of the law which may influence the size of the uninsured population, particularly the provision that allows children to remain on their parents plan until age 26.

Projection of state uninsured rate for adults post-Obamacare is calculated as:

Number of Uninsured Adults Pre-ACA – New Medicaid Enrollees – Net Private Plan Enrollees

Total net private plan enrollees is calculated by multiplying total private plan enrollees by the proportion estimated to have been previously uninsured (57% in the main findings).

Sources: The data used to compile this report is courtesy of the Kaiser Family Foundation, the Centers for Medicare and Medicaid Services, the Department of Health and Human Services, and the U.S. Census Bureau.

Author

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John Kiernan is Senior Writer & Editor at Evolution Finance. He graduated from the University of Maryland with a BA in Journalism, a minor in Sport Commerce & Culture,…
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Discussion

 
By: JG1987
May 21, 2015
I haven't even read the whole article yet, but something stands out that just frustrates me to no end. In two of the graphs, there's no key. What do the colors mean!!! I really hope John S Klernan answers this. There's nothing at stake for me here but I have this obsessive nature and not knowing for what each color stands will drive me NUTS!
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By: Tuhaybey
Nov 24, 2014
You can see a list of the states with the most, and the fewest, uninsured people per capita- http://politicsthatwork.com/graphs/uninsured-by-state
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