The Affordable Care Act Having an Impact in Some States but not Pennsylvania

In my post on Pennsylvania's uninsured, I wrote that the Affordable Care Act (ACA) was having little effect in Pennsylvania's rate of uninsured.  I wrote in another post that I received skeptical comments on my first post. I said in that post that I would look at changes in the rates in other states.  I couldn't then because the government shutdown also shutdown the US Census Bureau site.  The Advisory Board has come out with an image that can be updated on how many sign up for the state based exchanges which are not federal.

Now that the shutdown is over I can look at the Census Data for the Small Area Health Insurance Estimates (SAHIE) for states from 2008 thru 2011.  To determine which states had a significant decline in the uninsured rate from 2010 to 2011 (the period where portions of the ACA have taken effect such as allowing parents to keep their kids on their insurance until age 26), I marked a state as declined if it had a rate that declined outside its margin of error (MOE).  There were 14 states with a significant change in their rates and 37 (including DC) that either stayed the same or increased.   States with larger populations have smaller margins of error.  

Five of the states are summarized in the graph above, California, Massachusetts (which has it's version of the ACA), Pennsylvania, Texas (with the largest rate in the US), and Vermont (which is the first in the US to pass a single payer plan).  California, Texas, and Vermont had significant decreases in the rates while Pennsylvania and Massachusetts remained within the margin of error (MOE) of 0.2% for both years.  Missouri is the only state that showed a significant increase in it's rate from 15.3% to 16.0%.

ACA Decrease in uninsured * Medicaid Expansion Crosstabulation
		Medicaid Expansion			Total
		not participating or considering not participating	participating or leaning	expanding through alternate means or considering
ACA Change in uninsured	No	16	15	6	37
	yes	6	8	0	14
Total		22	23	6	51

I tried to see if there was any association between decreases in the rates and other state level variables but there was none.  The table above shows that there is no relationship between a significant decrease in the rate and whether or not the state is participating in Medicaid Expansion (p=0.254).  PA Gov. Corbett has proposed a draconian version of Medicaid expansion which Lloyd Stires has written extensively about.   Below is a table showing where each state stands on the ACA decrease and Medicaid expansion.

	State	ACA Change in uninsured	Medicaid Expansion
1	Alabama	No	not participating or considering not participating
2	Alaska	No	not participating or considering not participating
3	Arizona	No	expanding through alternate means or considering
4	Arkansas	No	expanding through alternate means or considering
5	California	yes	participating or leaning
6	Colorado	No	participating or leaning
7	Connecticut	No	participating or leaning
8	Delaware	No	participating or leaning
9	District of Columbia	No	participating or leaning
10	Florida	No	not participating or considering not participating
11	Georgia	No	not participating or considering not participating
12	Hawaii	No	participating or leaning
13	Idaho	yes	not participating or considering not participating
14	Illinois	yes	participating or leaning
15	Indiana	No	expanding through alternate means or considering
16	Iowa	No	expanding through alternate means or considering
17	Kansas	yes	not participating or considering not participating
18	Kentucky	No	participating or leaning
19	Louisiana	No	not participating or considering not participating
20	Maine	No	not participating or considering not participating
21	Maryland	yes	participating or leaning
22	Massachusetts	No	participating or leaning
23	Michigan	yes	participating or leaning
24	Minnesota	No	participating or leaning
25	Mississippi	No	not participating or considering not participating
26	Missouri	yes (only one that increased)	not participating or considering not participating
27	Montana	No	not participating or considering not participating
28	Nebraska	No	not participating or considering not participating
29	Nevada	yes	participating or leaning
30	New Hampshire	No	not participating or considering not participating
31	New Jersey	No	participating or leaning
32	New Mexico	No	participating or leaning
33	New York	yes	participating or leaning
34	North Carolina	No	not participating or considering not participating
35	North Dakota	No	participating or leaning
36	Ohio	No	participating or leaning
37	Oklahoma	No	expanding through alternate means or considering
38	Oregon	yes	participating or leaning
39	Pennsylvania	No	expanding through alternate means or considering
40	Rhode Island	No	participating or leaning
41	South Carolina	yes	not participating or considering not participating
42	South Dakota	No	not participating or considering not participating
43	Tennessee	No	not participating or considering not participating
44	Texas	yes	not participating or considering not participating
45	Utah	No	not participating or considering not participating
46	Vermont	yes	participating or leaning
47	Virginia	No	not participating or considering not participating
48	Washington	No	participating or leaning
49	West Virginia	No	participating or leaning
50	Wisconsin	yes	not participating or considering not participating
51	Wyoming	No	not participating or considering not participating

**Related Posts**

National, State, & County Uninsured Estimates

Obama on the Employer Mandate: ". . . never mind"

Save Dollars. Save Lives: An evening with Dr. Gerald Friedman