Census: Uninsured Rate Dips Below 10 Percent

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By Alex Ruoff

Sept. 13 — New government numbers showing a decline in the U.S. uninsured rate to below 10 percent cheered supporters of the Affordable Care Act, but Republicans remained firm in their criticism of the health-care law.

Four million Americans gained health insurance in 2015, reducing the number of uninsured in the country to 29 million, according to data released Sept. 13 by the government.

The data from the U.S. Census Bureau “provide very clear evidence that health reform is dramatically reducing the number of uninsured,” Robert Greenstein, president of the Center on Budget and Policy Priorities, a Washington-based think tank, told reporters Sept. 13.

The portion of the U.S. population without health insurance fell 1.3 percentage points from 10.4 percent to 9.1 percent between 2014 and 2015, according to the Census. Both the uninsured rate and number of Americans without health coverage are the lowest on record but whether they represent an all-time low remains unclear, according to CBPP.

The data also revealed that states that expanded their Medicaid programs under the Affordable Care Act saw the largest reduction to their uninsured rates, White House advisers pointed out in Sept. 13 blog post.

The increase in insurance coverage stands as a victory for the Obama administration. Since Obama’s signature health-care legislation, the ACA, took effect in 2010, the uninsured rate fell from a peak of 16 percent of the U.S. population in 2010 to 9.1 percent in 2015, according to the CBPP.

GOP: At What Cost?

However, Republican lawmakers remain dedicated to repealing and replacing the ACA. Senate Majority Whip John Cornyn (R-Texas) in a floor speech Sept. 13 called the law “a disaster for many of the people that I represent in Texas” due to increases in insurance premiums.

The Census figures follow a March report by the Department of Health and Human Services that estimated 20 million Americans gained health insurance coverage between 2010 and 2016. Census figures are considered the gold standard for determining the uninsured rate.

Medicaid Expansion

Most of 23 states that hadn't expanded their Medicaid programs under the ACA by Jan. 1, 2015, saw smaller declines to the rate of uninsured compared to those states that expanded their Medicaid programs, David Waddington, division chief of the Social, Economic and House Statistic Division of the U.S. Census Bureau, told reporters on a conference call Sept. 13.

Nineteen states hadn't expanded their Medicaid programs as of Sept. 1, according to the Kaiser Family Foundation.

The states with the highest uninsured rates in 2015 were Texas at 17.1 percent, Alaska at 14.9 percent and Oklahoma and Georgia at 13.9 percent each. All didn't expand their Medicaid programs, according to Census data. All four states saw 3 percent to 5 percent decreases in their uninsured rate between 2013 and 2014, below the national average of 5.1 percent.

If every state had expanded its Medicaid program, 3.7 million more Americans would have insurance coverage, Greenstein said.

Medicaid coverage expansion was included as part of the ACA in 2010, but made optional by the Supreme Court in 2012. Expansion makes states eligible to receive increased federal funding for Medicaid services.

Expansion is intended to provide health insurance to those in the “coverage gap,” a crack people fall into when they earn too much to qualify for Medicaid but not enough to purchase private insurance through the ACA's marketplace. Expansion reduces the coverage gap by increasing Medicaid eligibility for people earning up to 138 percent of the federal poverty level.

The decision to expand Medicaid is often a political one, with Democrats supporting the move and Republicans opposing it (see related article) .

No Silver Bullet

While Medicaid expansion does give more people health insurance, it's not a silver bullet for states looking to improve the health of their residents, Helen Levy, a research professor at the Institute for Social Research at the University of Michigan, told Bloomberg BNA Sept. 13.

Health insurance coverage rates are affected by demographic data, such as age, race and income level, she said. Poor Americans tend to have much lower rates of insurance coverage than their wealthy peers.

“Expanding Medicaid in Texas and Florida wouldn't suddenly make them Vermont and Massachusetts,” Levy said.

Vermont had the lowest uninsured rate in 2015 at 3.8 percent, down from 7.2 percent in 2013, according to the Census. New York's uninsured rate was 7.1 percent in 2015, down from 10.7 percent in 2013.

Republicans Not Convinced

Despite the Obama administration's claim that the ACA has been a success, House and Senate Republicans plan to continue their efforts to replace the law.

Cornyn said the law has raised insurance premiums across the country and increased market concentration.

An August study released by consulting firm Avalere Health found that nearly 55 percent of exchange market rating regions may have two or fewer carriers in 2017, nearly 36 percent of the market regions may have only one participating carrier “and there may be some sub-region counties where no plans are available.”

Rep. John Shimkus (R-Ill.), a member of House Energy and Commerce Subcommittee on Health, told Bloomberg BNA that House Republicans want to continue their plan for a full repeal and replacement of the ACA, as opposed to piecemeal fixes. He said that effort will begin again in 2017 and will be largely shaped by the November elections.

“If Trump doesn't win, then we'll have a harder time,” Shimkus said.

Data, History

The U.S. uninsured rate reached a low in 2015 but researchers are hesitant to declare it the lowest ever.

The Census Bureau has collected data about the number of insured in the U.S. since 1987 but has dramatically changed how it collects the information, making it difficult to compare the new data with data beyond 2013, Matt Broaddus, a research analyst with the CBPP, told Bloomberg BNA.

Researchers with the Centers for Disease Control and Prevention have done surveys about insurance coverage since 1997, he said. But those data aren't considered as robust as the Census data, making comparisons between the two difficult, Broaddus said.

The CDC data showed that the national uninsured rate hovered around 16 percent between 1997 and 2011.

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bna.com

To contact the editor responsible for this story: Kendra Casey Plank at kcasey@bna.com

For More Information

More about the Census findings can be found at http://www.census.gov/library/publications/2016/demo/p60-257.html.

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