The number of people in Washington State without health insurance continued to drop in 2016, according to new data released this week by the Census Bureau. In fact, every state has seen a decrease in uninsured rates since the Affordable Care Act (ACA) came into effect.
Overall, 94 percent of Washingtonians had health insurance in 2016, up from 86 percent in 2013, before the Affordable Care Act’s exchanges opened for the first time. That’s almost 600,000 people who gained health insurance!
Washington pulled ahead of many other states in insurance coverage, especially those that did not expand Medicaid or create exchanges under the Affordable Care Act. The 31 Medicaid expansion states had an average uninsured rate of 6.5 percent in 2016, versus 11.7 percent in the states that did less to embrace the federal law.
Importantly, the data from the American Community Survey shows that Washington State is working to close the racial gap when it comes to health insurance coverage, although significant disparities remain. In 2013, pre-ACA rollout, 29.9 percent of Hispanic or Latino Americans did not have health coverage. In 2016, that figure dipped to 16.5 percent. Despite these gains, white, black and Asian Washingtonians still have much higher coverage rates than Hispanic and American Indians.
Interestingly, data show that the increase in coverage for all groups was largely through public, not private, insurers like Medicaid, with different margins for different racial and ethnic groups. Black survey participants experienced a 13.1 percent increase in coverage under public health insurance, with similar numbers for American Indians. Whites and Hispanics had about a 6 percent increase in public coverage, while insurance gains among Asians were mainly in the private market.
These trends likely reflect a number of factors including improved outreach and enrollment by state’s Health Benefit Exchange, rising income levels among Asians, and limited access to employer-based insurance among black, Latino, and Native communities. Low wage sectors like hospitality, retail, and the gig-economy remain the largest employers of black and native people and provide extremely limited workplace access to insurance. Jobs that lack affordable benefits or livable wages, along with persisting unemployment, create greater need among these communities for public insurance options.
It’s also likely that, with an additional year of experience under its belt, the Washington Health Benefit Exchange has improved its outreach and enrollment efforts among under-served populations.
Of the people who are uninsured, less than 2 percent are over 65 years old. The majority of uninsured Washingtonians are adults between 25 and 54 years old –mostly too old to be on their parents’ plans and too young to be on Medicare. More than 57 percent of Washington’s uninsured are male. It’s no secret that insuring the young and invincible remains one of the greatest changes of U.S. health reform, and recent conservative attacks on the individual mandate only stand to make the situation worse.
Public health insurance is also responsible for the dip in uninsured children under 17 years old, down to 3 percent in 2016 from 6 percent in 2013. In that period, the amount of children solely in private insurance programs – 58 percent remained unchanged, while those in public programs increased from 32 percent to 35 percent. Thanks, Apple Health for Kids!
Coverage gains were not equal across all parts of Washington. Grays Harbor County, for instance, had a 75.1 percent decrease in the amount of uninsured residents, down to 5.5 percent in 2016 from 22.1 percent in 2013. In Franklin County, however, the gains were more modest – down 30.3 percent, from 18.5 percent to 12.9 percent. (Unfortunately, the survey does not offer data on the less-populated counties in Washington.)
Counties like Grays Harbor have the most to lose from Congressional threats to repeal the Affordable Care Act. In June, all insurance carriers stopped offering plans in that county, citing the uncertainty of the current political climate. Insurance Commissioner Mike Kriedler was able to convince Premera to re-enter the county’s market at the last minute, but the reality is that for a number of counties, our state’s health insurance system is barely functioning above crisis aversion. Individuals in counties like Grays Harbor and Klickitat will have no more than two insurance carriers to choose from in the Exchange in the upcoming year; their fate in 2019 and beyond is uncertain.
National data from the American Community Survey affirms what Washingtonians already know on the ground—the Affordable Care Act is working. It only took three years for more than half a million Washingtonians to gain health insurance coverage since the law’s passage–those gains could be lost much quicker! It’s more important than ever to protect what we have and begin to work toward the next reform effort that will propel us toward true universal coverage.