Research Update: Uninsured Rate for Adults in Non-Expansion States Continues to Increase, Expanding Medicaid Could Reverse The Trend

Readers of SayAhhh! may have noticed the press coverage about the uninsured rate holding steady through 2017. While it is true that progress reducing the rate of uninsured children and the overall population has effectively stalled, there are some groups lagging behind. This week, I am reading studies about (1) the growing gap in the uninsured rate of adults in non-expansion states compared to expansion states, and (2) how non-expansion states could reverse the trend.

Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2017

A new report from the Centers for Disease Control and Prevention’s National Center for Health Statistics presents the most up-to-date coverage trends available from the National Health Interview Survey (NHIS).

What it finds

  • There is a growing gap in coverage for non-elderly adults between expansion and non-expansion states. In 2017, the gap reached a new record: a 9.9 percentage point difference between the rate of uninsured adults in expansion and non-expansion states (see chart below).
  • Non-expansion states had a statistically significant increase in the rate of uninsured adults from 17.5% in 2015 to 19.0% in 2017. In contrast, the rate of uninsured adults in expansion states continues to drop.

Why it matters

  • The results of the report show that coverage gains have stalled. There were not many significant changes between 2016 and 2017. The percent of uninsured children (0-17 years old) and adults by all age groups (18-24, 25-34, 35-44, and 45-64) did not change significantly. However, adults who were not poor (above 200% of the federal poverty line) had a significant increase in their uninsured rate, from 7.2% in 2016 to 8.2% in 2017.
  • Adults in non-expansion states had a significant increase in their uninsured rate between 2015 and 2017. This is an indication that adults in non-expansion are lagging behind adults in expansion states and there is potential for this gap to continue growing.

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The Urban Institute’s The Implications of Medicaid Expansion in the Remaining States: 2018 Update

This Urban Institute brief models the outcomes if the 19 remaining non-expansion states were to expand Medicaid. The author’s results compare 2019 under current law with 2019 if all non-expansion states expanded.

What it finds

  • There would be between 4.3 and 4.7 million fewer uninsured non-elderly adults, depending on take-up.
  • The uninsured rate for the non-elderly population in non-expansion states would decline from 16.9% to 12.6%, with expected take-up.
  • Federal spending on health care would increase by $32.1 – $37.8 billion, while state Medicaid spending would only increase by $2.3 – $3.0 billion.
  • States predicted to have the largest declines in their uninsured non-elderly population are in the South: Mississippi (6.1 percentage points), Alabama (5 percentage points) and Georgia (5 percentage points).

Why it matters

  • The National Health Interview Survey data show that the gap in coverage between adults in expansion and non-expansion states is increasing. The gap will likely continue to grow in the future as the Congressional Budget Office expects the repeal of the individual mandate to increase the uninsured non-elderly population by 8.5 million over the next ten years.
  • If non-expansion states expanded Medicaid, they could reverse this trend and begin to substantially decrease the rate of uninsured adults.