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Medicaid expansion, state exchanges drive greater drops in uninsured

Gallup poll finds continued reduction in rates of those with no health coverage

In the two years since the Affordable Care Act's two main mechanisms took effect, the rate of uninsured adults has dropped--especially in those states that set up their own health insurance exchanges and expanded Medicaid, according to a new Gallup poll.

Across all 50 states, the uninsured rate fell from 17.3 percent in all of 2013 to 11.7 percent in the first half of 2015, the poll finds. None of the states reported a statistically significant rise in the percentage of uninsured adults compared with 2013. The online marketplace exchanges opened in 2013, and the first states to expand Medicaid did so at the start of 2014, Gallup notes.

The poll--which breaks down the results by state--finds that states that expanded Medicaid and implemented a state exchange or state-federal partnership experienced a 44 percent drop in the rate of uninsured from 2013 to the first half of 2015, compared to a 28 percent drop for states that implemented only one or neither.

Additionally, seven of the 10 states that saw the greatest decrease in the rate of those uninsured both expanded Medicaid and established a state-based exchange or state-federal partnership. Arkansas and Kentucky, Gallup points out, boast the sharpest reductions in their uninsured rates since the beginning of 2014.

Medicaid expansion continues to be a hot-button political issue in the wake of the King v. Burwell ruling, with the Obama administration hoping to convince more states to expand the program even as some worry enrollment surges may jeopardize state budgets.  

The poll also found that in the first half of 2015, seven states have uninsured rates either equal to or below 5 percent, whereas Massachusetts was the only state that could say as much from 2008 through 2014. Now Texas remains the only state with an uninsured rate at 20 percent or greater, while in 2013 there were 14 states in which 20 percent or more were uninsured.

In 2014, the percentage of uninsured adults in some minority populations also decreased, but public health advocates note that insurance enrollment isn't enough to stem gaps in access to care: Newly insured individuals must get help learning how to use their coverage and navigate the system.

To learn more:
- here's the poll results

Related Articles:
Focus turns to Medicaid expansion in wake of King v. Burwell ruling
HHS: 16.4 million Americans gained health insurance under ACA
ACA lowers uninsured by 15M people, mostly in Medicaid expansion states
Focus shifts from health plan enrollment to healthcare outreach
Uninsured rate for Hispanic, black Americans dropped in 2014
Uninsured rate drops to 11.5 percent