Seven of the states with the largest reductions in uninsured rates since the implementation of the Affordable Care Act have both expanded Medicaid and established a state-based exchange or a state-federal partnership.
Since the signing of the Affordable Care Act (ACA) in 2010, uninsured rates have dropped nationwide from 17.3% in 2013 to 11.7% in 2015, according to a Gallup poll. Of the 10 states with the largest reductions in uninsured rates, 7 of them have expanded Medicaid and have either established a state-based exchange or a state-federal partnership. The remaining 3 have implemented only 1 or the other.
Arkansas, Kentucky, Oregon, West Virginia, and California have had the greatest net reductions in uninsured rates since the law took effect at the start of 2014. States that did not have significant reductions were Virginia, Wyoming, Kansas, Delaware, and South Dakota. Delaware, which had one of the lowest uninsured rates prior, had “less room for further reduction than most others.” South Dakota also did not see a decline in spite of implementing both major ACA mechanisms: expanding Medicaid and establishing an exchange or partnership. Of the 10 states with the least reduction in uninsured rates, half of them did not implement either of the two mechanisms.
For the eighth year in a row, Massachusetts had the lowest national uninsured rate and Texas had the highest. The 3 regions with the highest uninured rates were the South, Southwest, and Mountain West.
The data for this poll was collected as a part of the Gallup-Healthways Well-Being Index, using the question “Do you have health insurance coverage?” Phone interviews were conducted from January to December of 2015, using mobile phones and landlines. For 2013, the sample included 178,072 adults of 18 years and older in all 50 states; for 2015, the sample included 177,281 adults.
The year 2013 serves as the benchmark year for uninsured percentages due to the start of the ACA. Marketplace exchanges opened in October 2013 with new insurance plans purchased during the last quarter of that year that started in January 2014; Medicaid expansion began among participating states in January 2014, as well. State exchanges also included state-federal “partnerships” where states manage some functions and make decisions based on local market and demographic conditions.
American opinions of the ACA, or “Obamacare,” have changed little since 2013. Since Medicaid continues to expand only slowly, the “marketplace exchanges that enable people select and purchase their own plan directly from insurers will likely be the primary means by which the national uninsured rate might continue to decline in the immediate future,” according Gallup.