North Carolina’s uninsured rate dropped 13 percent in 2014, the first year that most Americans were required to have health insurance under the Affordable Care Act.
The new information from the National Center for Health Statistics is the first official government tally of the federal health law’s effect on the uninsured. Government statistics on uninsured rates lag by about year-and-a-half, so that last year’s data from the U.S. Census Bureau is not expected to be issued until September.
The Affordable Care Act became law in 2010 but the provision requiring most Americans to buy health insurance didn’t become effective until January 2014. Last year, about 357,000 people in North Carolina enrolled in an individual insurance policy, and most qualified for federal subsidies to offset the cost of the coverage.
As a result, the state uninsured rate dropped from 19.9 percent in 2013 to 17.3 percent in 2014.
The National Center for Health Statistics issued 2014 enrollment data on Tuesday. Though the tally comes from a much smaller survey sample than the national census, it is a “good indicator” of what the census will tell us this fall, said Rachel Garfield, a senior researcher at the Kaiser Family Foundation.
“This data is just as definitive,” Garfield said.
The NCHS data is based on a nationwide survey of 111,682 people – only 2,571 were surveyed in North Carolina.
This year, about 492,000 people in North Carolina have enrolled in ACA insurance policies, adding about 135,000 enrollees to the 2014 roster.
While the official tally of the current rate of uninsured won’t be out until next year, a recent Gallup poll put the figure at 16.1 percent for North Carolina.
Adam Linker, a policy analyst at the N.C. Justice Center, estimated that census data for 2015 will confirm the Gallup poll as accurate when the census is issued next year.
The census data tracks NCHS data but because they draw on different samples, the statistics are not identical. For example, the NCHS estimated that 19.9 percent of North Carolinians were uninsured in 2013. The Census figure for that year was 19 percent.
According to the NCHS, North Carolina’s uninsured rate was 21.5 percent in 2012, so when it fell to 19.9 percent in 2013 it dropped by nearly 7.5 percent in the year before the ACA kicked in. Garfield said the most likely reason for that decrease was the improving economy, which resulted in more people getting jobs and health insurance through their employers.
That likely means the 13 percent drop in the ranks of the uninsured from 2013 to 2014 was partially caused by a stronger state economy that added 107,700 jobs last year.
What’s more, the NCHS data show dramatic reductions in the uninsured rate from 2013 to 2014 in states that opted to expand their Medicaid programs under the ACA.
For populations aged 18 to 64 – those affected by Medicaid expansion – West Virginia’s uninsured rate plummeted from 28.8 percent to 12.2 percent. Arkansas tumbled from 27.5 percent to 15.6 percent. And Kentucky fell from 24.1 percent to 15.6 percent.
By comparison, North Carolina, which did not expand its Medicaid program, saw its rate for 18-to-64-year-olds fall by a much narrower margin: from 25.6 percent to 22.5 percent.
In North Carolina, about a half-million people could be eligible for health insurance under Medicaid if that program were expanded.
“One of the most striking things is you can see the effect of Medicaid expansion,” Linker said. “In North Carolina you could cut the uninsured rate in half perhaps if you expanded Medicaid.”
Republican critics of Medicaid expansion in North Carolina have said the program is inefficient and would burden the state’s budget.