A year and half after the Affordable Care Act went into effect, the percentage of Americans who lack health insurance continues to plunge, according to a new Gallup survey released Monday. The poll found that the uninsured rate in the U.S. fell from 17.3% in 2013 to 11.7% in the first half of 2015.
But the new figures also show that reductions in the uninsured rate have been greatest in the states that fully embraced the Affordable Care Act. Under the law, states have the option of establishing health insurance marketplaces of their own, partnering with federal authorities, or leaving the task entirely to the federal government. States also can choose whether to expand Medicaid coverage to more poor adults under the law, which 30 states and the District of Columbia have done, or not to.
The consequences of those choices are clear in Gallup’s findings: States that set up exchanges or collaborated with the federal government and also expanded Medicaid saw a much bigger drop in the share of residents without health insurance.
The 22 states that did both of those things saw their uninsured rates decline by 44 percent since the end of 2013, according to the poll. The average uninsured rate for those states is now is 8.9 percent. In the 28 states that failed to do either, the drop was 28 percent, and the average uninsured rate now stands at 13.4 percent.
Many of the states hostile to the Affordable Care Act already had uninsured rates above the national average prior to the law’s passage, and as rates have declined more rapidly in states that opted for full implementation, stark disparities have opened up between individual states. Rhode Island, which embraced the health care law, has the lowest uninsured rate at 2.7 percent, while Texas, which remains hostile to the law, has the highest rate at 20.8 percent, according to Gallup.
Seven states now have uninsured rates below 5 percent: Rhode Island, Massachusetts, Minnesota, Vermont, Connecticut, Iowa and Hawaii. Each created its own health insurance exchange and expanded Medicaid. Prior to this year, Massachusetts was the only state with an uninsured rate that low.
Arkansas, Kentucky, Oregon, Rhode Island and Washington state each saw their uninsured rate go down by 10 percentage points or more, and they all have a state-run exchange or a marketplace jointly managed with the federal government and expanded Medicaid. Notably, Gallup found that the steepest declines in uninsured rates came in two politically conservative states that fully implemented the law – Arkansas and Kentucky have seen their uninsured rates drop by 13.4 and 11.4 percentage points, respectively.
The findings, arriving just weeks after a Supreme Court ruling upheld the Affordable Care Act’s subsidies, are consistent with every public survey released since new Obamacare benefits became available at the beginning of last year, including other Gallup polling as well as recent findings by the Centers for Disease Control and Prevention.
Overall, the Department of Health and Human Services estimates that about 16 million people who were uninsured in 2013 now have coverage.
Of course, the uninsured rate is only one measure of the law’s effectiveness. Other notable achievements of the law include impressive results on premiums and customer satisfaction rates; the lowest increase in health care spending in 50 years; the growing number of insurers who want to participate in exchange marketplaces; the reduced financial stress on families; the efficacy of the medical-loss ratio; and the reduced medical errors system-wide.