The Center's work on 'Medicaid' Issues

Coverage Gap Widening Between Medicaid Expansion States and Others

September 18, 2014 at 11:53 am

People in states that have adopted health reform’s Medicaid expansion had a lower uninsured rate in 2013 (before the expansion took effect) than people in non-expansion states — and non-expansion states are falling further behind in 2014, several recent government and independent surveys reveal.

Some 14.1 percent of the people in the 27 states (including Washington, D.C.) that have expanded Medicaid lacked health insurance in 2013, compared to 17.3 percent in the 24 non-expansion states, according to the Census Bureau’s American Community Survey (see chart).

Next year’s Census data, which will reflect the substantial coverage gains expected in expansion states in 2014 due to the expansion (which took effect January 1), should show a further widening of this coverage gap.

Results from several independent surveys — and this week from the Centers for Disease Control and Prevention (CDC), the first government survey data showing health reform’s early impacts — show that this is already happening.  For example, the Urban Institute’s Health Reform Monitoring Survey found that the uninsured rate for non-elderly adults in expansion states fell from 16.2 percent to 10.1 percent between the third quarter of 2013 and the second quarter of 2014, compared to a decline from 20.0 percent to 18.3 percent in non-expansion states.

Health reform’s Medicaid expansion creates a pathway to coverage for all non-elderly adults with incomes up to 138 percent of the poverty line, including, for the first time, low-income adults without children.  However, the 2012 Supreme Court decision upholding health reform made the expansion a state option.  States can opt in to the expansion at any time; the federal government will pick up all of the cost through 2016 and nearly all of the cost thereafter.

Census Data Show Continued Wide Disparities in Health Coverage

September 17, 2014 at 11:46 am

Certain groups of Americans continue to be uninsured at particularly high rates, the new Census Bureau data show.  African Americans and Hispanics, residents of the South and West, adults under age 35, and households with incomes under $50,000 had uninsured rates in 2013 well above the national average of 13.8 percent (see chart).  Hispanics’ 24.3 percent uninsured rate, for example, was nearly twice the national average.

These estimates, from the Current Population Survey (CPS), are the best source for comparing coverage rates among population groups in a single year but can’t be compared to CPS estimates from previous years because of changes to the CPS questions for 2013.  For health coverage trends over time, one should look instead to Census’ American Community Survey data, which we discussed yesterday.

Health reform’s major coverage expansions — the Medicaid expansion in many states to cover more low-income adults and the availability of subsidies for private marketplace coverage — will help reduce the disparities in health coverage among population groups.  But the expansions didn’t begin until 2014, so the new Census figures for 2013 don’t capture those coverage gains.  The Centers for Disease Control and Prevention released data yesterday covering the first quarter of 2014, and they show that the coverage gains in 2014 were greatest among some of the groups with the highest uninsured rates, including young adults, Latinos, and low-income households.

New CDC Figures Show Health Coverage Gains in the First Quarter of 2014

September 16, 2014 at 3:14 pm

Separate from the Census Bureau’s release today of official health coverage figures for 2013, the Centers for Disease Control and Prevention (CDC) issued preliminary data this morning showing that the ranks of the uninsured fell in the first quarter of 2014 by 3.8 million people.  The CDC data provide the first government survey data showing the early impacts of health reform’s major coverage expansions, which took effect in January 2014, in reducing the ranks of the uninsured.

The CDC figures are consistent with four independent surveys that also show significant gains in health coverage in 2014, particularly among states that have adopted health reform’s Medicaid expansion.

Some 13.1 percent of Americans were uninsured in the first quarter of 2014, the CDC data show, a 1.3 percentage-point decline from 2013 and the lowest uninsured rate since the CDC first collected these data in 1997.

Coverage gains were greatest among population groups historically least likely to have coverage.  The uninsured rate for adults under 26 plummeted from 26.5 percent in 2013 to 20.9 percent in the first quarter of 2014.  People in families under 200 percent of the poverty line, Latinos, African Americans, and people with less than a high school education also experienced disproportionately high coverage gains over this period.

The coverage gains among non-elderly adults were more than twice as large in states that have adopted the Medicaid expansion as in non-expansion states, widening the gap between the uninsured rates in the two groups of states from 4.3 percentage points to 5.8 percentage points.  (Expansion states have a non-elderly adult uninsured rate of 15.7 percent, compared to 21.5 percent for non-expansion states; see graph.)

The CDC data were collected in January-March and do not fully capture the significant enrollment growth in states’ Medicaid programs and health reform marketplaces that took place towards the end of this period, as the March 31 deadline for enrolling in marketplace coverage approached.  Data that include the second quarter of 2014 — as several of the independent surveys cited above did — will likely show even larger coverage gains.  For example, the Urban Institute’s Health Reform Monitoring Survey found that the uninsured rate among adults aged 18-64 fell from 17.9 percent to 13.9 percent between the third quarter of 2013 and the second quarter of 2014.

Later today, the Census Bureau may also release similar preliminary estimates for early 2014, but these estimates — unlike the CDC estimates discussed here — are the first in a new series and thus can’t be compared to estimates from earlier years.

Census Data Show Uninsured Rate Fell Slightly in 2013, Continuing Earlier Progress

September 16, 2014 at 12:55 pm

Some 14.5 percent of Americans were uninsured in 2013, Census figures released today based on the American Community Survey (ACS) show, a slight but statistically significant reduction from 2012’s 14.8 percent and well below the recent high of 15.5 percent in 2010 (see graph).

The most widely used source of health coverage information is the Current Population Survey (CPS), but, as Census officials explained this morning, changes instituted to it in 2013 don’t allow for a historical analysis using CPS data.

Much of the improvement in health coverage since 2010 reflects health reform provisions permitting young adults to stay on their parents’ health plans until age 26 and building upon previous coverage gains for children under Medicaid and the Children’s Health Insurance Program by requiring states to keep their existing eligibility rules and procedures.

The results are for 2013 and so do not reflect the coverage gains in 2014 resulting from the major ACA coverage provisions, which took effect on January 1 — namely, the Medicaid expansion and subsidized marketplace coverage.  But updated data from four independent surveys show substantial reductions in the number and percentage of uninsured in 2014, particularly among states taking up the Medicaid expansion.

Consistent with those independent surveys, the Centers for Disease Control and Prevention (CDC) today released preliminary survey results showing a 1.3 percentage-point decline in the uninsured rate between 2013 and the first quarter of 2014, reflecting a 3.8 million reduction in the number without health coverage.  CDC data that include the second quarter of 2014 (as some of the independent surveys cited above did) will likely show even larger coverage gains.

The CDC’s estimated 13.1 percent uninsured rate is the lowest since it began collecting these data in 1997.  (The CDC data are not directly comparable to the Census data cited above.)

Causes of Food Insecurity Go Well Beyond Low Incomes

September 16, 2014 at 10:37 am

With about 1 in 5 children (and 1 in 7 Americans overall) living in households where someone has trouble affording adequate food at some point during the year, a Brookings Institution report released yesterday reviews research findings on the causes of food insecurity among children and the effectiveness of policies to address it.  Not surprisingly, the report finds that families with low incomes are more likely to be food insecure.  But it also finds that other factors, such as the health of  caregivers and access to stable housing and child care, can influence children’s food insecurity — findings with important lessons for policymakers.

“[E]ven when income and other risk factors are accounted for, adult caregivers’ mental and physical health play a central role in children’s food security,” explains the report’s authors, the University of Illinois’ Craig Gundersen and the University of Kentucky’s James P. Ziliak.  Caregivers in food-insecure households were more likely to report physical and mental health problems, such as depression and substance abuse, than caregivers in food-secure households.

Other factors affecting food insecurity include child-care arrangements — children attending a child-care center were less likely to be food insecure than other children — lack of stable housing, and income instability, the report found.

In examining how well food assistance programs fight food insecurity, the report states, “in most studies, SNAP [i.e., food stamp] participation leads to substantial reductions in food insecurity.”  While SNAP recipients usually have higher rates of food insecurity than other low-income households, that’s because people often apply for SNAP in response to food insecurity, the report explains.

In a panel discussion after the report’s release, CBPP President Robert Greenstein cited its implications for policies in a number of areas, from health reform’s Medicaid expansion to providing more adequate child care funding.  For example, in the median state that hasn’t adopted the Medicaid expansion, a mother loses Medicaid eligibility when her income rises above just 47 percent of the poverty line; expanding Medicaid would enable these states to expand access to health care, potentially reducing food insecurity in households with children.