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Gallup Survey: States That Embraced Health Law See Big Drops in Uninsured

Medicaid expansion and state health exchanges get credit for reductions

A new Gallup survey finds that while most Americans continue to disapprove of the Patient Protection and Affordable Care Act (PPACA), the uninsured rate is declining, as the law intended.

Nationally, 17.3% of U.S. adults reported being without health insurance in 2013 — a rate that had slowly increased from 14.8% in 2008. The uninsured rate peaked at 18.0% in the third quarter of 2013 (the 3 months immediately preceding the opening of the health care exchanges) and has since declined to 13.4% in the second quarter of 2014 — the lowest quarterly rate in more than 6 years.

Arkansas and Kentucky lead all other states in the sharpest reductions in their uninsured rates among adult residents since the PPACA’s requirement to have insurance took effect at the beginning of the year. Delaware, Washington, and Colorado round out the top five.

All 10 states that reported the largest declines in uninsured rates expanded Medicaid and established a state-based marketplace exchange or state–federal partnership.

According to the Gallup survey, states that have implemented two of the PPACA’s core mechanisms — Medicaid expansion and state health exchanges — are seeing a substantially larger drop in the uninsured rate than are states that did not take both of these actions. Consequently, the gap in the uninsured that existed between the two groups in 2013 has now nearly doubled through the first half of 2014.

Many states continue to debate implementing these actions, Gallup finds. New Hampshire recently became the 26th state (plus the District of Columbia) to expand Medicaid, which takes effect this summer. Utah, a conservative state with a Republican governor, continues negotiations with the Centers for Medicare and Medicaid Services to have revised, more flexible terms than those detailed in the PPACA.

Gallup also finds that other states are debating dropping their state-based exchanges and moving to the federal exchange because of technological issues or unexpected cost-related challenges. Oregon has recently voted to move from a state-based to a federal-based exchange, whereas Maryland is modifying its troubled Web site to model Connecticut’s. Officials from the states of Massachusetts and Hawaii — both of which had comparatively low uninsured rates to begin with but show little or no change since 2013 — are also considering switching to the federal exchange, indicating that locally managed exchanges are not necessarily optimal for insurance sign-ups in some states.

The survey results were based on telephone interviews conducted from January 2 to December 29, 2013, in a random sample of 178,068 adults (aged 18 years and older) living in all 50 U.S. states and the District of Columbia. An additional 88,678 respondents were interviewed from January 2 to June 30, 2014.

Source: Gallup; August 5, 2014.

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