Percentage point decreases from 2013-2014 for persons 18-64 who were uninsured, by state Medicaid status and poverty status.
Percentage point decreases from 2013-2014 for persons 18-64 who were uninsured, by state Medicaid status and poverty status. Data courtesy National Center for Health Statistics.

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By Rose Hoban

New national numbers show that in states that have expanded Medicaid the rates of uninsurance have dropped at a faster rate than in states that didn’t expand the health care program for low-income people.

And North Carolina is among those states where, although the number of insured people is creeping up because of an improving economy, there are still a high rate of uninsured.

Data compiled by the National Center for Health Statistics show that the number of all people in the U.S. who are uninsured dropped from 14.4 percent in 2013 down to 11.3 percent in 2014.

But the difference in uninsured rates in so-called “expansion states” versus states that did not expand Medicaid are stark. Overall, states that expanded Medicaid, as allowed for under the Affordable Care Act, saw a drop in the ranks of the uninsured from 13 percent in 2013 to 9.3 percent in 2014.

North Carolina is one of the 22 states that have not considered expanding Medicaid, the program that serves low-income children, some of their parents, people with disabilities and low-income seniors. In states not expanding Medicaid, the number of uninsured dropped from 16 percent in 2013 to 13.5 percent in 2014.

The latest estimate of the number of people between 18 and 64 years old in North Carolina who remain uninsured is at about 17.2 percent, according to data from the National Health Interview Survey, the same source for the National Center for Health Statistics report.

“We are doing worse for uninsurance rates than the national average,” said Adam Zolotor, head of the North Carolina Institute of Medicine, who noted that was typical in non-expansion states.

But he did note some improvement in North Carolina’s numbers.

“People have been driven into the marketplace; that’s great news,” Zolotor said. About 463,000 people in North Carolina signed up for insurance in 2015 on the online health insurance marketplace created as a result of the Affordable Care Act.

”In addition, unemployment rates are down and my assumption is that employment-sponsored insurance is up,” he said.

Zolotor said more people have enrolled for Medicaid, in part because when they went to sign up for the health insurance marketplace they discovered they were eligible for Medicaid instead.

“We have seen an increase in Medicaid enrollment even without expansion,” noted Mark Holmes, a health economist at UNC-Chapel Hill’s Gillings School of Global Public Health. “Medicaid enrollment increased by about 300,000 in less than two years.”

The program had about 1.56 million beneficiaries in 2013, and has about 1.84 million beneficiaries now.

“Given that in general the economy is recovering, you’d be expecting Medicaid not to increase quite so fast,” Holmes said.

Percentage point decreases from 2013-14 for persons 18-64 who were uninsured, by state Medicaid status and poverty status. Data courtesy National Center for Health Statistics.

The NCHS report found the greatest gap in insurance came among people who earn below 138 percent of the federal poverty level ($15,836 for one person). People who fall into that income bracket would have benefitted most from expanding the program.

In states that expanded Medicaid, the rate of uninsurance dropped by 10.2 percent, whereas in states that did not expand the program the rate of uninsurance dropped by only 3.3 percent.

Health care advocates have been calling for North Carolina to expand the Medicaid program. While Gov. Pat McCrory and Department of Health and Human Services Sec. Aldona Wos have expressed interest, legislators have been cool to the idea.

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