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Premium subsidies, Medicaid expansion help slash uninsured rate


The uninsured rate has plunged 41% since key coverage provisions of the health care reform law began and the biggest gains have been in states that eased Medicaid eligibility requirements, according to an analysis released Thursday.

The Urban Institute analysis conducted for the Robert Wood Johnson Foundation found that 10.4% of individuals 18 to 64 years old were uninsured at the end of September.

That’s a nearly 41% drop from the 17.6% uninsured rate as of September 2013. That was several months before implementation of provisions in the Patient Protection and Affordable Care Act authorizing federal premium subsidies qualifying lower-income individuals can use to purchase coverage in public health insurance exchanges.

The provisions also boosted federal funding for states that expanded their Medicaid programs.

While all states saw their uninsured rates drop since the premium subsidy and Medicaid expansion provisions took effect, that drop was far greater in states that expanded Medicaid eligibility.

For example, the uninsured rate in September averaged 15.3% in states that did not expand Medicaid eligibility, down from 20.6% in September 2013, according to the study.

By contrast, in the 28 states, plus the District of Columbia, that expanded their Medicaid programs, the average uninsured rate fell to 7.3% in September versus 15.7% two years earlier.

“It is hard not to notice the big gap in coverage rates between states that have and states that have not expanded Medicaid,” Kathryn Hempstead, who directs coverage issues at the Robert Wood Johnson Foundation in Princeton, New Jersey, said in a statement.