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The Journal Gazette

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Wednesday, September 13, 2017 1:00 am

Ranks of uninsured shrinking

373,000 fewer Hoosiers lack coverage than did 4 years ago

BRIAN FRANCISCO | The Journal Gazette

The number of Hoosiers without health insurance has decreased by 373,000 since 2013, according to a report released Tuesday by the U.S. Census Bureau.

The bureau found that 530,000 Indiana residents, or 8.1 percent of the population, lacked medical insurance last year, compared with 903,000, or 14 percent, in 2013. Those numbers are close to nationwide uninsured rates of 14.5 percent in 2013 and 8.6 percent last year.

The decreases correspond with the 2013 implementation of the federal Affordable Care Act, which requires most Americans to carry medical insurance, and the related expansion of Medicaid coverage for low-income people in many states, including Indiana.

Census Bureau official Jennifer Cheeseman Day said in a teleconference that data analysts could not “tease out” how much of the improvement was linked to the Affordable Care Act and how much was the result of economic trends.

“Certainly we've seen improvements in the uninsured rate since after 2013, when many of the effects of the Affordable Care Act went into effect,” she said.

California saw its uninsured rate fall from 17.2 percent to 7.3 percent over the four-year period.

Massachusetts, which enacted state insurance mandates in 2006, had the lowest uninsured rate in the nation last year, 2.5 percent. The highest figure, 16.6 percent, was posted by Texas, which is among 20 states that have not expanded Medicaid.

Dr. Jonathan Walker, assistant clinical professor at the Indiana University School of Medicine in Fort Wayne, attributed the declines in uninsured Americans to the Affordable Care Act and Medicaid expansion.

“It is difficult to understand why there are still some states that are refusing to help their uninsured by expanding Medicaid. This refusal has resulted in millions of Americans struggling without access to care, and it is so counterintuitive that it seems to be an act of spite rather than considered policy,” Walker said in an email.

Many Republicans have sought the repeal and replacement of the Affordable Care Act, a signature piece of legislation of former Democratic President Barack Obama. Of the 20 states that have not expanded their Medicaid programs, 19 have GOP-controlled legislatures – and 17 have uninsured rates higher than the national average.

Walker said millions of Americans are still uninsured and the nation's health care system “remains fragmented and needlessly complex because it is beholden to the for-profit insurance industry. Those companies are giving us higher premiums, huge deductibles, narrower networks and Byzantine pharmacy benefits, and all that has nothing to do with the ACA. Nor do these things improve patient care, although they do ensure continued profitability for the industry.”

He added: “It would be so much better to at least talk about expanding and improving the one insurance that we all pay for – Medicare – in order to cover everyone.” Medicare is the federal insurance program for people 65 and older.

The Census Bureau report stated that for part or all of 2016, employer-based insurance covered 55.7 percent of the U.S. population, followed by Medicaid, 19.4 percent; Medicare, 16.7 percent; direct-purchase, including Affordable Care Act, 16.2 percent; and military coverage, 4.6 percent.

The only statistically significant change in coverage from 2015 to 2016 was in Medicare. Its coverage rate increased by 0.4 percentage point, which the Census Bureau said was likely the result of the growth in the 65-and-older population.

bfrancisco@jg.net