Health insurance numbers released from the U.S. Census Bureau show decreases in the rate of the uninsured in all 50 states and the District of Columbia. These numbers, which cover calendar year 2013 and calendar year 2014, allow us for the first time to look at how the policies of the Affordable Care Act have affected the nation’s overall insurance rate.
The state-by-state breakdown shows that Massachusetts continues to have the lowest uninsured rate in the country, with just 3.3 percent of its population reporting no insurance coverage in 2014. A review of the uninsured rates across all 50 states show that those states that opted to expand Medicaid and/or ran their own marketplace (or worked closely with the federal government on marketplace planning) saw the greatest decreases in the uninsured. Of the 14 State-based Marketplaces, only one chose not to expand Medicaid; of the 27 states that elected to use the federally facilitated marketplace, only four elected to expand. States with already low insurance rates, many of which were offering robust Medicaid programs prior to 2014, saw moderate but important decreases, as uninsured rates dipped below six percent in the District of Columbia, Hawaii, Minnesota, and Vermont.
|STATE||2013 UNINSURED RATE||2014 UNINSURED RATE||% Change|
|State-based Marketplaces that use the federal marketplace IT solution**|
|Federally Facilitated Partnership***|
|Federally Facilitated Marketplace****|
* State-based marketplaces: States assume all responsibility for operation and maintenance of a marketplace.
**State-based marketplace using the federal marketplace IT solution: A state that is operating its own marketplace, but requests that CMS performs eligibility and enrollment functions using federal IT systems.
*** Federally facilitated partnership: CMS is responsible for establishing and operating the eligibility and enrollment and financial management functions, while the state assists with the plan management and/or consumer assistance.
**** Federally facilitated marketplace: Federal government assumes all responsibility for operation and maintenance of a marketplace.
° During the first open enrollment, Oregon had its own state platform and performed as an SBM. For the second open enrollment period (for coverage for 2015), Oregon elected to instead use the federal platform for its eligibility and enrollment, but continues to perform other SBM functions.