The Census data released today from the American Community Survey (ACS) shows that 616,000 Kentuckians or one in seven residents did not have health insurance in 2013, which is about what the uninsured rate was the previous year. Although Kentucky is making big gains in this area because of the Medicaid expansion and Kynect, they will not be reflected in Census data until next year. What the new data does show is how desperately Kentucky needed the coverage that is now available.
The new ACS data—for which respondents were asked if they had health insurance at the time they were surveyed—was collected between January and December 2013. Kentucky’s expansion of Medicaid eligibility through the Affordable Care Act (ACA), which qualified those with incomes up to 138 percent of the federal poverty level, did not go into effect until January 2014. The open enrollment period for Kentucky’s new health insurance exchange started on October 1, 2013—but only a portion of ACS respondents were surveyed during this time period, and enrollment in private insurance through the exchange is only a small part of the health insurance story in Kentucky. Of the more than 521,000 who received health coverage through Kynect, just about 15 percent did so with the private policies available through the exchange with the remainder signing up for Medicaid.
Census data in recent years has already shown that the ACA is reducing the share of young adults in Kentucky without health insurance as a result of the provision allowing them to stay on their parents’ insurance until age 26. Between 2010 and 2012, the share of 18 to 24 year olds in Kentucky with no health insurance dropped from 33 percent in 2010 to 26 percent in 2012. The share of Kentuckians in this age group with private insurance grew from 56 percent in 2010 to 62 percent in 2012.
While the overall impact of the ACA on Kentucky will be much better understood when the 2014 Census data is released next year, the 2013 data also does show how great the need for insurance was in 2013. The 616,000 Kentuckians without health coverage last year is a statistically significant increase from the 595,000 who were uninsured in 2012. However, the increase in the share that was uninsured from 13.9 percent last year to 14.3 percent in 2013 was not statistically significant.
What is clear from the data is that Kentucky entered the period in which coverage began to be available through Kynect and Medicaid with a large and persistent need for health care, aggravated by the ongoing weak economy and eroding employer coverage of health care.
Although it is not reflected in the new Census data, the ACA is dramatically increasing the share of Kentuckians with health insurance. Approximately 75 percent of those receiving insurance through Kynect were previously uninsured. A recent Gallup Poll estimates that the state’s uninsurance rate for adults dropped from 20.4 percent last year to 11.9 percent midway through 2014. And Kentucky’s Medicaid commissioner Lawrence Kissner recently reported that prior to the ACA at least 17 percent of residents were uninsured in 75 Kentucky counties, but it’s likely that now no counties have such a large share without coverage; the rate of uninsured may have fallen to less than five percent in four southeast Kentucky counties.
National sources also suggest that next year’s Census data will paint a similar picture for states that expanded Medicaid through the ACA. The Centers for Disease Control (CDC) just reported that the share of adults ages 18-64 without health insurance at the time of the interview during January through March 2014 was 18.4 percent, down from 20.4 percent in 2013. In those states that expanded Medicaid, the percentage decreased from 18.4 percent in 2013 to 15.7 percent in the first three months of 2014. In states that did not expand Medicaid, there was no corresponding significant decrease.
The Urban Institute’s Health Reform Monitoring Survey also shows a drop in the uninsured rate from the end of 2013 to the middle of 2014, with much greater increases in insurance coverage in states that adopted the Medicaid expansion. RAND’s Health Reform Opinion Study and the Commonwealth Fund’s Affordable Care Act Tracking Survey also show significant decreases in adults without health coverage between 2013 and 2014.