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Obamacare year one: Where uninsured rates dropped the most

November 3, 2014

    Emily Hatton, The Daily Briefing

    It's been about a year since the Affordable Care Act's exchanges opened for business. And that year has brought a lot of change for the insurance markets.

    As we prepare for the exchanges to reopen for their second year on Nov. 15, the Daily Briefing is taking a look back on 2014 and how it has affected each state. After culling through available data on uninsured rates, Medicaid enrollment, and commercial insurance exchanges, we've put together an interactive map to illustrate what has changed. (See more about how we made the map.)

    Filter the map by:

    Where uninsured rates dropped the most

    It's still early to assess uninsured data from 2014; most go-to data sources have not yet released information about the year. To get some early insight, we used data from a Gallup survey released earlier this year.

    According to the data, the five states that experienced the largest reductions in their uninsured rate from 2013 to 2014 were:

      1. Delaware, where the uninsured rate decreased by 68.57%;
      2. Arkansas, where it decreased by 44.89%;
      3. Kentucky, where it decreased by 41.67%;
      4. Connecticut, where it decreased by 39.84%; and
      5. Washington, where it decreased by 36.31%.

    It's no surprise that all these states expanded Medicaid, and most of them created their own insurance exchange. (Only Delaware and Arkansas did not launch state health insurance exchanges, instead urging consumers to use the federal one.)

    Three states wanted to lead on Obamacare. One is setting the pace.

    Overall, New York Times' "The Upshot" blog notes, states that "fully embraced" the ACA are the ones who did the best.

    In Arkansas, the uninsured rate dropped 10 percentage points, from 22.5% in 2013 to 12.4% in 2014. Joe Thompson, Arkansas' surgeon general, credits the decrease to his state's unique solution for Medicaid expansion, which uses federal funding to purchase insurance subsidies for low-income residents. He says approximately 80% of residents who bought new coverage in Arkansas did so with those subsidies.

    Where uninsured rates did not go down

    The Gallup data found that three states saw their uninsured rates increase—and two saw no change at all:

      1. Kansas, where the uninsured rate increased by 40.8%;
      2. Iowa, where it increased by 6.9%;
      3. Virginia, where it increased by 0.75%;
      4. Massachusetts, where the uninsured rate did not change;
      5. Utah, where the uninsured rate did not change.

    However, it's important to note that the margin of error for the 2013 Gallup data was +/- 1 to +/- 2 percentage points. For the 2014 uninsured data, the margin of error was as high as +/- 5 percentage points for states with smaller populations.

    What do Obamacare plans cover? It really depends on the state

    The states making the bottom five list from the Gallup data do so for different reasons.

    In Kansas, experts say the lack of Medicaid expansion was a key factor. Kansas Insurance Commissioner Sandy Praeger also says that the public now has a better understanding of insurance coverage, making people less likely to accidentally report that they have insurance if they do not. Praeger also suggested Gallup's polling methodology may have influenced the data.

    In contrast, Gallup's Dan Witters says that Massachusetts made the bottom five because it already had a very low uninsured rate prior to 2014.

    Want to know more? Join us for a 'Pulse Check' on Obamacare

    Big court cases. New insurance premium rates. ACO dropouts. The Affordable Care Act has been in the news a lot these past few weeks, and it isn't going anywhere.

    Attendees will:

    • Learn our latest insights about health insurance exchanges
    • Get a sneak peek into our ongoing research on the ACA's delivery system reforms
    • Understand the current status of ACA implementation


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