UNITED STATES – November 29, 2023 – Although there is no place in the United States where everyone has health insurance and, therefore, access to health care, there are ten states where the uninsured rate is less than 5 percent. About 26 million Americans (about 8 percent of the population) do not have health insurance. However, in 2010, the year that the Affordable Care Act (ACA) became law, there were more than 46 million uninsured Americans. Therefore, 20 million Americans have obtained health insurance after the enactment of the ACA in 2013. The ACA reduced the coverage gap between the government-funded Medicaid insurance for persons with low resources and those with commercial health insurance. It expanded Medicaid on a state-by-state basis and offered government subsidized commercial health plans to full-time workers and their families who did not qualify for private health insurance and allows people with pre-existent health conditions to obtain coverage.
According to 2022 data, the KFF reports that of the 50 states, the District of Columbia, and Puerto Rico, these are the top 10 jurisdictions with less than a 5 percent uninsured rate:
- District of Columbia
- Rhode Island
- New Hampshire
- New York
Of the states below the national average: North Carolina is 42nd with 9.4%; Florida is 48th at over 11%; and Texas is last with almost a 17 percent uninsured rate. A very interesting finding is that New Mexico is at the national average of 8 percent; but, in 2010, 23 percent of its population was uninsured.
It has been estimated that more than one-half of the uninsured are eligible for Medicaid or the ACA health plans. The most successful states have implemented specific policies that have expanded coverage. Massachusetts and New Mexico integrate the enrollment process for Medicaid and the ACA health plans and offer state-based financial assistance in addition to the federal subsidies. The ACA allows Minnesota and New York to offer a state-sponsored Basic Health Plans to persons who fall in the healthcare gap. The states were able to use the money saved by enrolling Medicaid beneficiaries into Medicaid managed care plans rather than the traditional fee-for-service model. Colorado and Washington promote the ACA health plans and offer some subsidies to undocumented immigrants whose earnings would qualify them for Medicaid expansion.
The percentage of uninsured Americans is greater than most of the world’s developed nations. The U.S. healthcare system has the most expensive cost of care on a per capita basis, yet is the 37th ranked country in quality of care. Health insurance provides people with some financial protection against expenses, but does not cover all of the bills. It provides hospitals and providers with some compensation for their efforts and services and sustains the bottom line.
Improving access to healthcare is one great step towards providing access for everyone, reducing medical debt and bankruptcies, and eliminating health disparities. Universal healthcare may be an aspiration rather than reality in this political climate. However, if each state diligently pursues signing up everyone who is eligible for Medicaid expansion and the ACA health plans, then there will be far fewer uninsured Americans.
According to Larry Levitt, executive vice president at the KFF health policy think tank, “No state has put all the pieces together to the full extent available under the ACA.”
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Contact: Dr. Dick Needleman, Health reporter, 103.3 AshevilleFM, firstname.lastname@example.org