New survey data released last week by the National Health Insurance Survey (NHIS) make it even clearer that the Affordable Care Act (ACA) has caused a dramatic drop in the number of Americans who are uninsured.  This Tuesday (Sept. 13) the Census Bureau will release more detailed data, including state-level uninsured rates, and we will learn how Wisconsin is doing compared to other states.

Last week’s NHIS figures show that in the first three months of 2016 the nation’s uninsured rate fell to the lowest level ever recorded.  As the graph illustrates, the percentage of people without health insurance dropped by nearly half over the last six years, from 16% in 2010 to 8.6% during the first quarter of this year.

The NHIS data show that the uninsured rate among children under age 18 has fallen to 5%, compared to almost 14% in 1997, prior to implementation of the Children’s Health Insurance Program.

A different data set released in recent weeks provides county-level uninsured rates for 2014. Known as the Small Area Health Insurance Estimates (SAHIE), it combines survey results and administrative data sources to produce estimates on insurance coverage rates in every county.

We have mapped the change in the insured rate in Wisconsin from 2013 to 2014, when the new federal health insurance Marketplace was initiated and the state made substantial changes to BadgerCare (greatly expanding coverage for childless adults, while cutting in half the income eligibility ceiling for parents).  As the first map illustrates, the estimated insured rate rose by at least nine-tenths of a percentage point in every county in 2014.

The second map shows the county-by-county estimates of the percentage point change in the portion of children under 19 who were insured in 2014. It shows a somewhat different picture, with modest gains in many counties, but small decreases in coverage in 21 counties.  It should be noted that the county-level estimates have a high margin of error, and for that reason the small changes in 2014 and the differences between counties generally aren’t statistically significant.

Although one shouldn’t put much emphasis on the change in any specific county, the aggregate picture is very relevant.  The SAHIE data, like the 2014 data from the American Community Survey, show that insurance rate for children Wisconsin didn’t improve much in Wisconsin in 2014, despite substantial gains in many other states.

As we explained in a recent paper, one likely reason why ACA implementation didn’t improve children’s coverage in our state in 2014 is that about 60,000 parents lost their BadgerCare eligibility. Although their children generally remained eligible, parents often renew their kids’ coverage at the same time that they renew their own.  As a result states that expand Medicaid eligibility for parents see increases in enrollment of children, and vice versa. (Read more in Health Care for Kids: How Wisconsin Lost and Could Regain Its National Prominence.)

Another possible factor is that there was a lot of turmoil in the insurance market in Wisconsin in 2014, and some of the gains in coverage probably occurred after people had been surveyed by the Census Bureau.  That’s one of the reasons why we are very anxious to see the next batch of state level data.

On September 13, the Census Bureau will release the estimated uninsured rates for each state in 2015, based on the American Community Survey.  We will be analyzing that ACS data carefully and are hoping it will answer several important questions:

• Has Wisconsin achieved Governor Walker’s goal of a 50% reduction in the uninsured rate?
• How are we doing compared to the 31 states that have expanded Medicaid to cover all adults below 138% of the federal poverty level?
• Will Wisconsin’s rank in the insurance rate for children, which was once near the very top, drop again in 2015?
• Will we see gains in kids’ coverage that support the hypothesis that the lackluster progress for kids in our state in 2014 was partially a short-term result of turmoil and confusion about BadgerCare?

We will try to answer those questions in one or more blog posts next week.  Stay tuned!

Jon Peacock