Stark Uninsured Rate Differences Across the Country

The difference in uninsured rates in states that have embraced the Affordable Care Act and those that have not became even starker in 2014, according to new results from the Gallup-Healthways Well-Being Index.

Since the healthcare law’s requirement for individuals to have health insurance took effect at the beginning of 2014, the uninsured rates in Arkansas and Kentucky have dropped the most, by -11.1 and -10.6 percentage points, respectively. The uninsured rate in Kentucky is now below 10%.

“While a majority of Americans continue to disapprove of the Affordable Care Act, it has clearly had an impact in reducing the uninsured rate in the US, which declined to its lowest point in seven years by the last quarter of 2014,” according to Gallup. “This trend could be poised to continue, as 55% of Americans who remain uninsured plan to get health insurance rather than pay a fine.”

Of the 11 states to report the largest reductions in percentage of residents who are uninsured from 2013 to 2014, only Montana did not expand Medicaid and form a state exchange or a state-federal partnership.

The nation’s uninsured rate fell from 17.3% to 13.8% with no states reporting a statistically significant increase in the percentage of uninsured—Kansas reported an increase of 1.9%. In the 21 states that chose to both expand Medicaid and set up their own state exchanges or partnerships in the health insurance Marketplace, the uninsured rate declined 4.8 percentage points compared to 2.7 percentage points in the 29 states that implemented 1 or neither of these parts of the healthcare law.

For the seventh consecutive year, Massachusetts reported the lowest uninsured rate (now at 4.6%). On the other end of the spectrum, Texas has maintained the highest uninsured rate for just as long (now 24.4%). However, this is the lowest percentage of uninsured to date for Texas.

“States that have implemented two of the law's core mechanisms—Medicaid expansion and state health exchanges—are seeing a substantially larger drop in the uninsured rate than states that did not take both of these actions,” Gallup’s analysis concluded. “Consequently, the gap in uninsured rates that existed between these two groups in 2013 nearly doubled in 2014.”