Medicaid expansion creates haves and have-nots
Uninsured Americans are becoming more concentrated in states that have not expanded Medicaid, raising concerns that there may be two different Americas when it comes to healthcare access.
Southerners, Spanish speakers and high-school dropouts represent a growing portion of the uninsured, according to a survey from the Urban Institute’s Health Policy Center.
As of June, 60.4% of individuals lacking coverage lived in the 25 states that had not expanded Medicaid to adults with incomes up to 138% of the federal poverty level (New Hampshire’s expansion started Aug. 1, reducing that number to 24). That’s up from 49.7% of the uninsured living in those states last September.
Southern states are disproportionately represented among non-expansion states, with Arkansas and Kentucky as exceptions. As a result, the share of the uninsured residing in southern states grew from 41.5% to 48.9% between September 2013 and June 2014.
Nationally, the uninsured rate dropped from 17.9% in the third quarter of 2013 to 13.9% in the second quarter of this year, according to the Urban Institute. That represents a decrease of roughly 8 million in the number of uninsured non-elderly adults. The findings track recent survey results from Gallup, which showed the uninsured rate has dropped from 17.1% to 13.4% since the fourth quarter of 2013.
For Medicaid expansion states, the uninsured rate among non-elderly adults dropped from 15.1% to 10.1%, according to the Urban Institute survey. But for non-expansion states, the decrease was just two percentage points, from 20.3% to 18.3%.
At the same time, the share of uninsured individuals who reported Spanish as their primary language grew from 17.0% to 19.9%, and the percentage of uninsured high-school dropouts increased from 23.8% to 28.1%.
Affordability was the most common reason cited by survey respondents for not getting coverage, with 59.5% indicating that healthcare insurance was too expensive. But ignorance about the availability of subsidies may have led some people to wrongly conclude they couldn’t afford coverage. Only 38.2% of survey respondents said they were familiar with subsidies that could offset premiums and out-of-pocket costs.
Stephen Zuckerman, co-director of the Health Policy Center, argued that signing up the uninsured will become more difficult in future open-enrollment periods because those who really wanted coverage are now insured.