Med­i­caid ex­pan­sion cre­ates haves and have-nots

Modern Healthcare - - NEWS - By Paul Demko

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.

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