Gallup Survey Shows Uninsured Rates In Missouri And Kansas Continue To Fall
The proportion of Missourians without health insurance fell by 4.3 percentage points from 2013 to the first half of 2015, according to Gallup survey results published Monday.
The rate of uninsured Missourians now stands at 11.4 percent, compared with 15.2 percent in 2013.
The decrease occurred even though Missouri neither expanded Medicaid nor set up its own state-based marketplace under the Affordable Care Act.
"We've been doing better with our marketplace plan than most other states," says Tim McBride, a health economist at Washington University in St. Louis, explaining one reason for the substantial drop in Missouri.
He says the major health foundations in Kansas City and St. Louis "have been putting a lot of effort into getting the word out about the marketplace."
"So even though we don't have Medicaid expansion, Missouri has been doing quite well in the marketplace," he says.
Seven of the 10 states with the biggest reductions in uninsured rates implemented Medicaid expansion and established a marketplace while two did one or the other, according to Gallup.
Nationwide, the uninsured rate plunged from 17.3 percent in 2013 to 11.7 percent through the first half of this year.
The data, collected as part of the Gallup-Healthways Well-Being Index, are based on daily surveys conducted from January through June 2015 in which respondents were asked, “Do you have health insurance coverage?” The margin of error is 1 to 2 percentage points for most states except those with small populations, where it climbs to as much as 4 percent.
The drop in the uninsured rate comes two years after the Affordable Care Act (ACA), commonly called Obamacare, took effect. The rate is the lowest since Gallup began keeping track in 2008.
“The ACA is not only about health insurance coverage, but that’s its primary focus and so, looking at the percentage of folks that are uninsured, it’s a great measure to see how well it’s doing. And clearly it’s carrying out its primary purpose,” says Sheldon Weisgrau, director of the Health Reform Resource Project in Topeka.
The survey is the first since the Supreme Court ruled last month that, under the ACA, premium subsidies are available in states that did not set up their own insurance exchanges, or marketplaces, as well as in states that did.
Kansas, which like Missouri did not expand Medicaid or set up its own insurance exchange, also saw a drop in its uninsured rate, albeit a more modest one that its eastern neighbor. According to Gallup, the rate dropped from 12.5 percent in 2013 to 11.3 percent in the first half of 2015.
“We would have much lower uninsured rates,” Weisgrau says, had Kansas and Missouri expanded Medicaid or established their own marketplaces,
“In general, if we had the political will to do one or the other or preferably both, we would be in really good shape in terms of looking at our uninsured rate compared to other states, especially when you look at where we started,” Weisgrau says, referring to Kansas in particular.
Expansion would make all adults with incomes up to 138 percent of the federal poverty level eligible. That translates into $16,105 in annual income for an individual and $32,913 for a family of four.
Pleas by health advocates and hospitals in Missouri and Kansas to expand Medicaid have fallen on deaf ears. Legislators in both states say they’re concerned about the costs of expansion, even though the federal government is paying for 100 percent of expansion through 2016 and no less than 90 percent after that.
Recent reports by the Robert Wood Johnson Foundation and the Kaiser Family Foundation concluded that expansion saves states money by allowing them to use federal funds instead of state dollars to provide health services to pregnant women, prison inmates, people with mental illness and disabilities, and others.
States that both expanded Medicaid and set up their own marketplaces saw their uninsured rate drop from 16 percent in 2013 to 8.9 percent, according to Gallup, a 44 percent drop. States that implemented one or neither went from 18.7 percent to 13.4 percent, a 28 percent drop.
Arkansas and Kentucky saw the biggest reductions in their uninsured rates since the ACA took effect at the start of 2014, according to the survey. Arkansas’ plummeted from 22.5 percent to 9.1 percent. Kentucky’s fell from 20.4 percent to 9 percent.
Dan Margolies, editor of the Heartland Health Monitor team, is based at KCUR.