US uninsurance rate continues to decline, but state actions threaten gains

The latest findings on US health insurance coverage from the first quarter of the current year continue what is becoming a familiar story: The portion of the US population without health insurance continues to decline. This year, the estimate from CDC's National Center for Health Statistics is that 8.6% of US people of any age were without health insurance at the time of interview from January - March 2016.

As it did last year, the report highlights the difference between states that have accepted the Affordable Care Act's Medicaid expansion and those that have not:

In Medicaid expansion states, the percentage of uninsured adults decreased, from 18.4% in 2013 to 9.2% in the first 3 months of 2016. In nonexpansion states, the percentage of uninsured adults decreased, from 22.7% in 2013 to 16.7% in the first 3 months of 2016.

At this time last year, 30 states and the District of Columbia had accepted the Medicaid expansion. In June of 2016, Louisiana joined the list of expansion states, and less than seven weeks after opening enrollment it announced that 250,000 new adults had signed up for its expanded Medicaid program, Healthy Louisiana. As of July 7th, 19 states still have not accepted the Medicaid expansion.

State actions also have the potential to reduce the progress in expanding insurance coverage that we've seen since the Affordable Care Act's passage in 2010, when 15.4% of the US population lacked health insurance. Arizona, Kentucky, and Ohio have all proposed changes to their Medicaid programs that would require premium payments from low-income adults -- and almost certainly result in many impoverished adults losing coverage. Last week, HHS rejected Ohio's request to make these changes, and I anticipate similar rejections of the Arizona and Kentucky proposals. Even so, this is a reminder that progress toward near-universal health insurance coverage needs sustained support from elected officials if we're going to continue reducing the percentage of the US population without health insurance.

Some of our past posts on the Medicaid expansion

Supreme Court decision is great for public health – but fate of 16 million poorest uninsured is still unclear (June 2012)
What happens to the poorest residents in states declining the Medicaid expansion? (April 2013)
Medicaid opt-out resulting in enormous losses for community health centers (May 2014)
ACA predicted to have positive impact on insurance disparities; Medicaid expansion key to widening access for black Americans (December 2014)
Report: Expanding Medicaid programs a win for both residents and state budgets (March 2016)
Multiple chronic conditions and Medicaid expansions (August 8, 2016)

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It is appalling how strongly planted the right's feet are against helping to care for people in this country, but as they feel (and sn, the poster at #1 here, has said) "If people are poor they deserve to be poor."