Let’s Take a Look at the Uninsured and How the Affordable Care Act has Changed Things

ObamaCare’s uninsured rates drop more in states that embraced the law. Despite opposition to Medicaid and subsidies, uninsured rates continue to fall. Even with an uninsured rate nearing 10%, there is a long way to go to ensure near universal coverage.

To clarify as of Q1 2016 (according to census data, see our breakdown of that data):

  • Total Uninsured Rate: 8.6% (exceeded 10%)
  • 18-64 Only: 11.9% (nearing 10%)
  • 0-17 Only: 5.0%
  • Over 65: Not typically counted in ACA-related studies, it’s near 100% according to this study (but not exactly 100%).

Below we look more at the uninsured rates over time, and we examine who the uninsured are, how not having coverage affects their lives, and how this affects our economy. We will also look at the differences between how the Affordable Care Act affected uninsured rates in states that embraced the law’s major provisions, as opposed to states who rejected them.

FACT: According to a 2017 CBO Report on the American Health Care Act: In 2026, an estimated 52 million people would be uninsured [under the Republican plan], compared with 28 million who would lack insurance that year under current law [ObamaCare]. In other words the uninsured rate is at an all-time low at around 8.6% (for ages 0-65; according to 2016 census data) and is projected to double to a modern high by 2026 if the Republican repeal and replace plan is passed as written.

The ACA and Uninsured Rates: States that embraced setting up their own marketplaces and expanding Medicaid made big headway in reducing numbers of uninsured, while states that rejected and fought the program have seen less success.

FACT: According to a November 2015 Kaiser poll on the uninsured. Only 11% of uninsured polled knew open enrollment started on November 15th, 2014.  Get the facts on open enrollment in the Health Insurance Marketplace.

Current Uninsured Rate

According to the CDC and Census data, for the first three months of 2016 the uninsured rate was 8.6% in 2016 down from 9.2% in 2015, and from 15.7% before the Affordable Care Act was signed into law. For just the 18 -64 demographic the same study shows the uninsured rate at 11.9%, down from 13% in 2015, down from 22.3% in 2010 when the ACA was signed into law. These represent the lowest uninsured rates in over 50 years according to the studies (which are all based on census data).

Another highly respected survey from Gallup showed that as of January of 2015, before the 2015 open enrollment period data, the uninsured rate was 12.9% on average from the fourth quarter of 2014. By the second quarter of 2015, the uninsured rate had fallen to 11.4%, down from 11.9% in the first quarter of 2015. This was down from a high of 18% and a low of 14.4% in 2008.

Both of the above studies should be taken into account when trying to understand what an exact uninsured rate is as they both rely on survey data as well as actual enrollment numbers (although I would suggest erring on the side of the Census data).

While it may seem as though ObamaCare isn’t making much of dent, that view is inaccurate. According to an April 2014 CBO report, the uninsured rate is projected to drop sharply during 2016 open enrollment as more Americans become aware of the fee and subsidies and continue to fall until around 2024.

Latest uninsured Rate: As of first quarter of 2016 the uninsured rate is 11.9% for Americans 18 – 64 and 8.6% for all Americans.

gallup-healthways-2nd-quarter-2015-aca-uninusred

uninsured-rate-since-1963

FACT: According to an ongoing NHIS / CDC study the current uninsured rate of 9.2% for 2015 is the lowest in over 50 years. This has been true since the uninsured rate of all Americans hit 11.4% in Q2 2014.

Get more facts on the ObamaCare enrollment numbers, or keep reading about the uninsured.

Who are the Uninsured?

There is a common misconception that the Uninsured are comprised of those who don’t want insurance or don’t have jobs, both of these ideas are myths. In 2012, 47.3 million people in the U.S. under age 65 lacked health insurance. The majority of these uninsured were working families who can’t afford or don’t have access to health insurance. Let’s take a look at some statistics about the uninsured:

  • In 2010 16% of uninsured were full-time workers or their dependents.
  • The primary reasons for Americans being uninsured are cost and job loss.
  • Poor working families are the most likely to be uninsured.
  • Uninsured Americans cost the American healthcare system an additional $49 billion each year. Only 12% of uninsured families pay their hospital bills in full. This includes families making over $88k a year.
  • According to a 2014 Kaiser poll on the uninsured, 62% thought health insurance was very important and 22% thought it was somewhat important.  Additionally, 70% of people who were uninsured thought health insurance was something they needed.

Want to learn more about the uninsured? See this study done by RWIF.org on understanding the uninsured or learn more about who the uninsured are from KFF.org.

COMPARE: Unpaid hospital bills = $49 billion in 2011. Cost of ObamaCare = $76 billion net in 2015.

The Uninsured are About 25% More Likely to Die

A 2012 familiesUSA study shows that more than 130,000 Americans died between 2005 and 2010 because of their lack of health insurance. The number of deaths due to a lack of coverage averaged three per hour and that the issue plagued every state. Other studies have shown those statistics to be high or low, but all studies agree: In America, the uninsured are more likely to die than those with insurance.

The uninsured:

  • are less likely to have a usual source of care outside of the emergency room
  • often go without screenings and preventive care
  • often delay or go without needed medical care
  • pay more for medical care

How Does ObamaCare Help the Uninsured?

Keeping the above statistics on the Uninsured in mind the Affordable Care Act set out the solve the problem of working families not being able to afford insurance with three important provisions:

1. State-based exchanges (marketplaces) reduce out-of-pocket costs and premium costs by offering subsidies to low and middle-income families.

2. The expansion of Medicaid to the 138% Federal Poverty Level (FPL) allows Americas poorest working families to get coverage through Medicaid. Those with no incomes were almost all eligible for Medicaid before the law passed.

3. The “employer mandate” requires large businesses to offer coverage and tax credits offered to small businesses to subsidize coverage.

Beyond these three major provisions, the ACA includes a large number of provisions that help improve access to Health Insurance and health care. You can check out all the benefits of ObamaCare here.

Who Rejected the Exchanges?

States could have choose to set up their own exchange as the law originally intended or they could defer to the Federal Government which would set up a marketplace for them. As it turned out only 17 states set up a marketplace, while the other 33 did not. While this didn’t necessary determine whether a state would be effective in reducing their uninsured, there was some correlation as you will see by the post-2014 open enrollment statistics on the reduction of uninsured under ObamaCare below.

state health insurance exchanges

Rejection of Medicaid Expansion

One of the most important provisions of the law in regards to reducing the number of uninsured people in each state was Medicaid expansion. Medicaid expansion expands Medicaid eligibility to 138% of the Federal Poverty Level (FPL) covering about half of the nation’s uninsured alone, helping to close the “Medicaid gap,” the gap between those who can afford insurance and those who qualify for Medicaid.

medicaid coverage gap

The law was originally intended to require all states to embrace expansion, but a court ruling from National Federation of Independent Business v. Sebelius allowed states to opt-out of expanding the program. The end result was 24 states rejecting expansion. Although many of the same states rejected both aspects of the program, some embraced one while rejecting the other. In many cases the states that needed it the most rejected expansion. The number one reason cited for rejecting expansion was cost.

Keep in mind the states that rejected both aspects of these programs as you look at the reduction of uninsured below. Also note, that more states are expanding each day. See an updated list here.

NOT PARTICIPATING (24 states)

  • Alabama*: Gov. Robert Bentley (R)
  • Alaska*: Gov. Sean Parnell (R)
  • Florida*: Gov. Rick Scott (R)
  • Georgia*: Gov. Nathan Deal (R)
  • Idaho*: Gov. C.L. Otter (R)
  • Indiana: Gov. Mike Pence (R)
  • Kansas: Gov. Sam Brownback (R)
  • Louisiana*: Gov. Bobby Jindal (R)
  • Maine*: Gov. Paul LePage (R)
  • Mississippi*: Gov. Phil Bryant (R)
  • Montana: (R)
  • Nebraska*: Gov. Dave Heineman (R)
  • North Carolina: Gov. Pat McCrory (R)
  • Oklahoma: Gov. Mary Fallin (R)
  • Pennsylvania*: Gov. Tom Corbett (R)
  • South Carolina*: Gov. Nikki Haley (R)
  • South Dakota: Gov. Dennis Daugaard (R)
  • Tennessee: Gov. Bill Haslam (R)
  • Texas*: Gov. Rick Perry (R)
  • Utah: Gov. Gary Herbert (R)
  • Vermont: Gov. Peter Shumlin (D)
  • Virginia: Gov. Bob McDonnell (R)
  • Wisconsin*: Gov. Scott Walker (R)
  • Wyoming*: Gov. Matt Mead (R)

PARTICIPATING (26 states and the District of Columbia)

  • Arizona*: Gov. Jan Brewer (R)
  • Arkansas: Gov. Mike Beebe (D)
  • California: Gov. Jerry Brown (D)
  • Colorado*: Gov. John Hickenlooper (D)
  • Connecticut: Gov. Dannel Malloy (D)
  • Delaware: Gov. Jack Markell (D)
  • District of Columbia: D.C. Mayor Vincent Gray (D)
  • Hawaii: Gov. Neil Abercrombie (D)
  • Illinois: Gov. Pat Quinn (D)
  • Iowa*: Gov. Terry Branstad (R)
  • Kentucky: Gov. Steve Beshear (D)
  • Maryland: Gov. Martin O’Malley (D
  • Massachusetts: Gov. Deval Patrick (D)
  • Michigan*: Gov. Rick Snyder (R)
  • Minnesota: Gov. Mark Dayton (D)
  • Missouri: Gov. Jay Nixon (D)
  • Montana: Gov.-elect Steve Bullock (D)
  • Nevada*: Gov. Brian Sandoval (R)
  • New Jersey: Gov. Chris Christie (R)
  • New Hampshire: Gov. Maggie Hassan (D)
  • New York: Gov. Andrew Cuomo (D)
  • New Mexico: Gov. Susana Martinez (R)
  • North Dakota*: Gov. Jack Dalrymple (R)
  • Ohio*: Gov. John Kasich (R)
  • Oregon: Gov. John Kitzhaber (D)
  • Rhode Island: Gov. Lincoln Chaffee (I)

indicates a state’s participation in the multi-state lawsuit against ACA

Go Here For Governor’s Statements on the Medicaid Expansion.

medicaid expansion map

The Employer Mandate and Small Business Tax Credits

While tax credits offered to small businesses have been helping to allow small businesses to afford to offer health coverage since 2010, the employer mandate has been pushed back time and time again. The mandate, while important to reducing the uninsured, is pretty controversial and is currently the basis of a lawsuit against the President. Regardless of the suit, the truth is neither side of the aisle has embraced this aspect of the law. We, as a nation, need to decide if business should be in charge of providing health insurance. If not then we need another solution.

Learn more about the recent employer mandate lawsuit here.

Reduction in Uninsured By State

States that rejected both the exchanges and Medicaid expansion, unsurprisingly, tended to see the lowest reduction in uninsured while those who embraced both saw the biggest changes. Of course, every state has its own story.

• Massachusetts embraced reform before the rest of the country with “RomneyCare” and thus saw small reductions to their already low uninsured rate.

• Those who fared the worst, like Mississippi, already had one of the largest uninsured populations in the country and would have had one of the biggest concerns with the cost of the program.

The following statistics are from wallethub.com and are taken from data they have collected and analyzed including a recent study by the Kaiser Family Foundation (KFF).

 State by State Reduction in Uninsured 2014

Uninsured Rank

State Name

Uninsured Rate Pre-Obamacare

Projected Uninsured Rate Post-Obamacare

Difference Before and After

1 Massachusetts 4.35% 1.20% -3.16%
2 Rhode Island 14.34% 5.60% -8.73%
3 District of Columbia 9.09% 6.29% -2.80%
4 Hawaii 9.11% 6.35% -2.75%
5 Oregon 16.91% 6.38% -10.54%
6 West Virginia 17.34% 6.59% -10.74%
7 Minnesota 10.07% 6.61% -3.47%
8 Iowa 11.58% 7.47% -4.11%
9 Washington 16.01% 8.27% -7.73%
10 Kentucky 17.30% 8.95% -8.35%
11 Colorado 16.54% 9.02% -7.52%
12 Maryland 14.91% 9.13% -5.77%
13 Wisconsin 11.64% 9.75% -1.89%
14 New York 13.39% 10.16% -3.23%
15 Pennsylvania 13.27% 11.05% -2.22%
16 Ohio 15.19% 11.27% -3.92%
17 Virginia 14.91% 12.45% -2.46%
18 Tennessee 15.70% 12.46% -3.24%
19 Indiana 14.80% 12.78% -2.02%
20 Kansas 15.46% 12.91% -2.55%
21 Missouri 16.49% 12.95% -3.55%
22 New Jersey 16.83% 13.54% -3.29%
23 Utah 15.96% 13.57% -2.38%
24 Nebraska 14.71% 13.69% -1.02%
25 Arkansas 20.87% 13.77% -7.10%
26 South Carolina 19.25% 13.97% -5.28%
27 Illinois 16.16% 14.16% -2.01%
28 California 21.00% 14.26% -6.74%
29 Idaho 19.12% 14.41% -4.72%
30 South Dakota 15.88% 14.71% -1.17%
31 Alabama 15.97% 15.44% -0.53%
32 Arizona 20.13% 16.38% -3.74%
33 North Carolina 19.64% 16.68% -2.96%
34 Montana 21.98% 17.65% -4.34%
35 Georgia 21.66% 18.16% -3.50%
36 Wyoming 18.92% 18.29% -0.63%
37 Oklahoma 19.76% 18.33% -1.43%
38 Alaska 20.48% 18.96% -1.52%
39 Nevada 26.52% 19.58% -6.94%
40 New Mexico 24.29% 19.59% -4.69%
41 Florida 24.73% 19.61% -5.12%
42 Louisiana 22.41% 20.91% -1.50%
43 Mississippi 18.11% 21.46% 3.34%
44 Texas 26.80% 24.81% -1.99%
N/A Connecticut 9.50% N/A N/A
N/A Delaware 12.22% N/A N/A
N/A Maine 11.53% N/A N/A
N/A Michigan 13.46% N/A N/A
N/A New Hampshire 14.16% N/A N/A
N/A North Dakota 11.80% N/A N/A
N/A Vermont 9.28% N/A N/A
NATIONAL 17.87% 14.22% -3.66%

State by State Uninsured Rate By Source 2014

State Name

Uninsured Pre Obamacare

Projected Uninsured (RAND 28%)

Projected Uninsured (McKinsey 36%)

Projected Uninsured (Kaiser 57%)

Projected Uninsured (HHS 87%)

Alabama 15.97% 16.13% 15.94% 15.44% 14.73%
Alaska 20.48% 19.55% 19.39% 18.96% 18.35%
Arizona 20.13% 17.00% 16.83% 16.38% 15.75%
Arkansas 20.87% 14.29% 14.14% 13.77% 13.24%
California 21.00% 15.48% 15.15% 14.26% 12.99%
Colorado 16.54% 9.84% 9.61% 9.02% 8.18%
Connecticut 9.50% N/A N/A N/A N/A
Delaware 12.22% N/A N/A N/A N/A
District of Columbia 9.09% 6.85% 6.70% 6.29% 5.70%
Florida 24.73% 21.43% 20.93% 19.61% 17.72%
Georgia 21.66% 19.23% 18.94% 18.16% 17.05%
Hawaii 9.11% 6.57% 6.51% 6.35% 6.12%
Idaho 19.12% 16.04% 15.59% 14.41% 12.72%
Illinois 16.16% 14.73% 14.57% 14.16% 13.56%
Indiana 14.80% 13.49% 13.29% 12.78% 12.04%
Iowa 11.58% 7.80% 7.71% 7.47% 7.14%
Kansas 15.46% 13.60% 13.41% 12.91% 12.19%
Kentucky 17.30% 9.60% 9.42% 8.95% 8.29%
Louisiana 22.41% 21.67% 21.46% 20.91% 20.12%
Maine 11.53% N/A N/A N/A N/A
Maryland 14.91% 9.52% 9.41% 9.13% 8.73%
Massachusetts 4.35% 1.36% 1.32% 1.20% 1.03%
Michigan 13.46% N/A N/A N/A N/A
Minnesota 10.07% 6.91% 6.83% 6.61% 6.29%
Mississippi 18.11% 22.17% 21.97% 21.46% 20.72%
Missouri 16.49% 13.82% 13.58% 12.95% 12.04%
Montana 21.98% 18.95% 18.59% 17.65% 16.30%
Nebraska 14.71% 14.48% 14.26% 13.69% 12.88%
Nevada 26.52% 20.15% 19.99% 19.58% 19.00%
New Hampshire 14.16% N/A N/A N/A N/A
New Jersey 16.83% 14.17% 14.00% 13.54% 12.89%
New Mexico 24.29% 20.13% 19.98% 19.59% 19.04%
New York 13.39% 10.81% 10.63% 10.16% 9.49%
North Carolina 19.64% 17.96% 17.61% 16.68% 15.36%
North Dakota 11.80% N/A N/A N/A N/A
Ohio 15.19% 11.74% 11.61% 11.27% 10.79%
Oklahoma 19.76% 18.96% 18.79% 18.33% 17.69%
Oregon 16.91% 6.97% 6.81% 6.38% 5.76%
Pennsylvania 13.27% 11.91% 11.67% 11.05% 10.17%
Rhode Island 14.34% 6.55% 6.29% 5.60% 4.62%
South Carolina 19.25% 14.83% 14.59% 13.97% 13.08%
South Dakota 15.88% 15.25% 15.10% 14.71% 14.15%
Tennessee 15.70% 13.27% 13.04% 12.46% 11.62%
Texas 26.80% 25.74% 25.48% 24.81% 23.85%
Utah 15.96% 14.54% 14.27% 13.57% 12.58%
Vermont 9.28% N/A N/A N/A N/A
Virginia 14.91% 13.37% 13.12% 12.45% 11.51%
Washington 16.01% 9.07% 8.85% 8.27% 7.45%
West Virginia 17.34% 6.97% 6.87% 6.59% 6.21%
Wisconsin 11.64% 10.58% 10.35% 9.75% 8.89%
Wyoming 18.92% 18.99% 18.80% 18.29% 17.56%
NATIONAL 17.87% 15.08% 14.85% 14.22% 13.32%

FACT: By 2024, when the law is theoretically fully in effect and uninsured is at its lowest, 25% of the uninsured will qualify for Medicaid. They will either be in a non-expansion state (5%), or won’t know about, or won’t get, free or low-cost coverage despite being eligible (20%).

Learning More About the Uninsured

Aside from the Gallup Poll and Kaiser Studies mentioned on this page, reliable sources for learning about the uninsured are the official HHS blog and the longest running non-federal healthcare survey, Commonwealth Fund. This 2014 article from the NYtimes from 2014 also has a breakdown of uninsured facts state-by-state. Or learn more about Understanding ObamaCare enrollment numbers.

How to Reduce the Uninsured Rates Moving Forward

To reduce the uninsured rate in America, it will require that we as a country, and that includes each state, move toward expanding Medicaid and either embracing the employer mandate or simply find a better solution. While we as a country fight over whether the law should be or not exist, millions of hard working Americans are going without coverage. Learn more facts about the uninsured and the Affordable Care Act now on our ObamaCare Facts page.

Who are the Uninsured and How is the ACA Helping?
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