Last year, 8.6 percent of Americans lacked health insurance. Three years earlier, that figure was 14.5 percent, meaning that the rate dropped by 5.9 percentage points over the period that the Affordable Care Act went into effect, a 40 percent decline from the 2013 figure. In real terms, that’s about 19 million fewer people lacking health insurance, per estimates released Tuesday by the Census Bureau.
There’s a big split, though, between those states that took advantage of the ACA’s expansion of Medicaid and those that didn’t. On average, states that expanded Medicaid at the outset now have an uninsured rate of about 6.1 percent, a decline of 5.9 percentage points since 2013. In those states that never expanded Medicaid, more than 10 percent of the population lacks insurance on average, and the decline since 2013 is a more modest 4.6 percent.
That overview having been duly noted, the patterns on a state-by-state basis are fascinating. Below, the change from 2013 to 2016 in every state, with a number of other factors indicated: the national rate of change, whether the state expanded Medicaid (and if so, when) and how the state voted in 2016 (which often correlates to the expansion question). Some thoughts after all the graphs.
Notice how the red/Medicaid lines curve downward at a faster rate than the national rate while the blue/no-expansion lines tend to drop more slowly. In states such as Indiana and Montana, which expanded Medicaid in the middle of this period, the rate of decline increased after the expansion.
These aren’t uniform changes; Delaware, for example, had a slower rate of decline than the national figure — but it also has a lower rate of uninsured people. On average, the states that expanded Medicaid have consistently had lower rates of uninsured residents than the national mark while those that didn’t expand have had higher numbers.
It’s interesting to compare a state like Nevada with one like Texas. In each state, more than a fifth of the population lacked insurance in 2013. Nevada expanded Medicaid and had a drop of 9.3 points in its percentage of uninsured residents. Texas didn’t expand — and in 2016, 16.6 percent of its population lacked insurance. That’s a higher percentage than the national number before the ACA.
These graphs serve as a reminder of the politics of 2017, too. The expansion of Medicaid drove a lot of the decline in the number of people lacking insurance. Those who want to reform the ACA in a way that revokes that expansion will be advocating for moving a lot more people back into the ranks of the uninsured.
In only three of the above graphs did the lines go up between years: South Dakota had an increase in 2015, and D.C. and Nebraska had increases in 2016. Every other year in every other state, the rate of the uninsured fell.