WASHINGTON -- The share of Americans without health insurance has dropped sharply since enrollment under the Affordable Care Act began in 2013, according to survey results published by Gallup on Monday. And the law's effects are even more dramatic in states that cooperated with the federal government instead of fighting Obamacare.
Nationwide, the uninsured rate fell from 17.3 percent in 2013 to 11.7 percent through the first half of this year, following two years of sign-ups for private health insurance on the Obamacare exchanges and for expanded Medicaid benefits, the pollsters found. The contrast between Obamacare-friendly states and those hostile to the law is stark. Rhode Island has the lowest uninsured rate, 2.7 percent, while Texas comes in last at 20.8 percent.
States have the option of establishing health insurance marketplaces of their own, such as Covered California and Kentucky's Kynect; to partner with federal authorities, as Delaware, Illinois and others did; or to leave the task entirely to the U.S. Department of Health and Human Services, which the majority of states did. States also can choose whether to offer Medicaid coverage to more poor adults under the law, which 30 states and the District of Columbia have done.
The consequences of those choices are clear in the Gallup 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.
In the 22 states that had done both things by Dec. 31, the uninsured rate declined by 44 percent, and now is 8.9 percent. In states that did neither, the drop was 28 percent, and the uninsured rate is currently 13.4 percent. Collectively, the 28 states that are resisting the Affordable Care Act already had higher uninsured rates prior to the law's enactment than the 22 that have accepted it.
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.
Indiana and Pennsylvania adopted Medicaid expansions this year, but are not counted with other states that did because the policy wasn't in place at the beginning of 2015. The District of Columbia is excluded from the survey.
The results of this Gallup-Healthways Well-Being Index survey are consistent with every public survey released since new Obamacare benefits became available at the beginning of last year, including recent findings by the Centers for Disease Control and Prevention.
The Department of Health and Human Services estimates 16 million people who were uninsured in 2013 have coverage this year. About 10 million individuals are enrolled in private plans obtained via the exchanges, and over 11 million more people signed up for Medicaid between 2013 and this January, the department also reported.