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The nation’s uninsured rate continues to fall even as premiums rise for health plans on exchanges under the Affordable Care Act, according to industry analysts and new reports tracking health coverage.
Nationally, the uninsured rate for “nonelderly adults” dropped below 10% this spring , which many analysts say is more related to an increasing number of states expanding Medicaid coverage for poor Americans under the ACA. The rate of uninsured nonelderly adults was 17.6% in September of 2013, according to an analysis funded by the Urban Institute and the Robert Wood Johnson Foundation.
The rate of uninsured nonelderly adults has fallen below 10 percent as of March 2016, according to... [+]
“A single-digit uninsurance rate is a great achievement,” Kathy Hempstead of the Robert Wood Johnson Foundation said last week of the latest data compiled from the foundation-funded health reform monitoring survey.
There are 15.5 million fewer uninsured adults since September of 2013 with the rate of uninsured falling to less than 8% in states that had expanded Medicaid by January of 2016, the reform monitoring survey shows. “The percentage of uninsured adults in states that didn’t expand Medicaid (14.1%) is nearly double that of states that did expand Medicaid eligibility (7.3%),” the Robert Wood Johnson Foundation said.
But in states like Texas that have opted against expanding Medicaid, even the rising premiums on public exchanges aren’t deterring the uninsured from purchasing private coverage.
A report out Tuesday from Rice University and the Episcopal Health Foundation showed the uninsured rate among Texas adults falling steadily since September of 2013 “for every age, ethnic and income-level group across the state.” By March of this year, the rate of uninsured adults dropped to 18% from 26% in the fall of 2013, the Baker Institute report said.
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Texas is among the dwindling number of states that haven’t expanded Medicaid under the ACA, which means that the state’s uninsured rate has remained in the double-digit percentages.
Still, researchers from Rice University’s Baker Institute for Public Policy said the percentage of uninsured Texans dropped by more than 40% for those with annual incomes of between $16,000, the federal poverty level, and $47,000. And those at the lower income level tend to get large subsidies to buy coverage on exchanges and aren’t generally impacted by the rising rates that are beginning to be reported by big carriers like
“The rising premiums hurt those people who get a very small subsidy or no subsidy at all and those are the people who are getting pinched,” Vivian Ho, chair in health economics at the Baker Institute, said in an interview.
Still, the lack of a Medicaid expansion in Texas is keeping tens of thousands in the state from being insured. Ho and fellow researchers said nearly half of Texans earning less than $16,000 annually still don’t have health coverage.
There are now 31 states plus the District of Columbia that have expanded Medicaid, according to the latest information from the Kaiser Family Foundation, which tracks the program’s expansion.
After this year, it will cost Texas and the remaining 18 other states that have opposed Medicaid expansion in the form of a state contribution if they decide to expand after 2016. Under the ACA, 2016 is the last year states can expand Medicaid programs entirely with federal dollars.
From 2014 through this year, the expansion population is funded 100% with federal dollars.
Beginning next year, states gradually have to pick up some costs, but the federal government still picks up 90% or more of Medicaid expansion through 2020. It’s a better deal for states than before the ACA, when Medicaid programs were funded via a 50-50 split between state and federal tax dollars.
“The ACA as implemented in Texas offers little hope for Texans with the lowest incomes,” the Episcopal Health Foundation’s Elena Marks said in a statement accompanying the report. “They make too much to qualify for traditional Medicaid and not enough to get a subsidy to help pay for their premium. They’re stuck in the ‘coverage gap,’ and unless Texas expands Medicaid or comes up with another system of coverage for this group, they will remain uninsured."
