States with the biggest declines in the share of residents lacking insurance also have reported substantial financial benefits for their hospitals.


Feb. 25—The latest finding of declining numbers of uninsured links the biggest drops to states that have aggressively implemented the healthcare reform law.

Annualized uninsured rates dropped from 17.3 percent to 13.8 percent in 2014, which was the lowest rate found in the seven-year existence of the Gallup-Healthways Well-Being Index. The actual rate is likely lower, with Gallup having reported in January that the uninsured rate among U.S. adults in the fourth quarter of 2014 averaged 12.9 percent.

The latest survey credited the Affordable Care Act by highlighting that the steepest drops found in rates of uninsured residents generally occurred in states that had both implemented the law’s Medicaid eligibility expansion and at least partially operated their own public health insurance marketplaces. States taking both of those steps had a decline of 4.8 percentage points in their uninsured rate, compared with a decline of 2.7 percentage points in states implementing one or neither provision.

“While a majority of Americans continue to disapprove of the Affordable Care Act, it has clearly had an impact in reducing the uninsured rate in the U.S., which declined to its lowest point in seven years by the last quarter of 2014,” according to a Gallup written statement. “This trend could be poised to continue, as 55 percent of Americans who remain uninsured plan to get health insurance rather than pay a fine.”

The likelihood that the uninsured rate will fall further this year may have increased with the Obama administration’s recent announcement that it was extending open enrollment through April for uninsured residents who discover when filing taxes that they owe a penalty for lacking 2014 coverage.

Another indication that rates of uninsured may continue to fall was the administration’s Feb. 23 announcement that Medicaid added 10.75 million beneficiaries from October 2013 to December 2014, with total enrollment reaching 69.7 million people. Unlike in the public insurance marketplaces, which are open to most people only during certain periods, enrollment in Medicaid is available year-round. The Medicaid report echoed the Gallup findings in that it found Medicaid sign-ups jumped 27 percent in expansion states, compared with 7 percent in non-expansion states.

Hospital Impact

The states with the biggest drops in uninsured rates included some where hospitals reported favorable financial trends in 2014.

For instance, Arkansas led the nation in reducing its uninsured rate in 2014 with a drop of 11.1 percentage points, according to Gallup. Arkansas hospitals surveyed in November reported a 1.9 percent increase in emergency department (ED) visits in the first half of 2014 compared with the first half of 2013, but a 35.5 percent decrease in ED visits by uninsured patients during that period. The survey by the Arkansas Hospital Association and Arkansas Chapter of HFMA also found a 46.5 percent decrease in the number of hospitalized patients without insurance.

The second-largest drop in uninsured patients in the Gallup poll—10.6 percentage points—occurred in Kentucky, where hospitals’ uncompensated care visits declined 55 percent in the first three quarters of 2014, a Feb. 12 study found. The Deloitte Consulting study commissioned by Gov. Steve Beshear, a Democrat, also found that Medicaid expansion provided the state’s hospitals with $506 million in new revenue, with total revenue increasing 27 percent.

“The combination of increases in Medicaid payments and drastic reductions in uncompensated care means that in general, medical providers are earning more money than ever,” Audrey Tayse Haynes, secretary of the Cabinet for Health and Family Services, said in a written statement. “This flood of cash and increased patient load will likely result in additional hiring and expanded offices, which improves healthcare access to all Kentuckians.”


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare.

Publication Date: Wednesday, February 25, 2015