States made progress on coverage and access to care from 2013 to 2016

Forty-seven states saw their adult uninsured rate drop by five percentage points or more in the first three years following the Patient Protection and Affordable Care Act’s major health coverage expansions, according to a recent Commonwealth Fund scorecard assessing access to health care. The report, States’ Progress on Health Coverage and Access to Care, 2013-2016, found that New Mexico’s rate dropped the most between 2013 and 2016, from 28 percent to 13 percent. A dozen other states, meanwhile, saw double-digit drops: Arizona, Arkansas, California, Florida, Kentucky, Louisiana, Montana, Nevada, Oregon, Rhode Island, Washington, and West Virginia.

The Commonwealth Fund also found that the uninsured rate for children under age 19 also fell in most places, dropping by at least two percentage points in 33 states. Nevada saw the biggest drop—eight points—with Montana next at six points.

Recent policy actions, however, could reverse these gains in many states, the report concluded. If Congress repeals the ACA’s individual mandate, premiums for people buying health insurance on their own could become unaffordable for many. Of the 39 states using the federal marketplace, Nebraska, Wyoming, Alaska, and Iowa would see the biggest average dollar increases in premiums for people who buy coverage without subsidies.

In addition, the shortened open-enrollment period, cuts in advertising and outreach for ACA marketplace coverage, and failure to renew federal funding for the Children’s Health Insurance Program could potentially reverse states’ gains in access to health care.

“The ACA has successfully allowed states to expand health insurance to millions of their residents,” said Sara Collins, vice president for health care coverage and access at the Commonwealth Fund. “If people are going to continue to be able to get and afford the health care they need, it will be essential to hold on to and build on these coverage gains.”

State rankings.

The report analyzed state performance based on six measures of access and affordability. Massachusetts, the District of Columbia, Rhode Island, Connecticut, Hawaii, and Minnesota were top-ranked overall, while South Carolina, Mississippi, Wyoming, Texas, and Oklahoma came in at the bottom. When looking at trends over time, the scorecard found substantial improvement between 2013 and 2016 in most states, with some exceptions.

In nearly three-quarters of states, fewer people skipped needed health care because of costs in 2016 compared to 2013. Arkansas, California, Kentucky, New Mexico, Oregon, Tennessee, and Washington saw drops of between five and seven percentage points in the share of people who said they did not see a doctor because it was too expensive.

In more than half of states (30 states plus D.C.) the percentage of people at risk for poor health outcomes who did not have a recent routine doctor’s visit declined by at least two points. Arizona, Arkansas, California, Kentucky, Oklahoma, and Oregon saw gains of five points on this access measure.

The share of working-age adults and children in each state living in households that spent a large portion of their income on medical care was at least two percentage points lower in 25 states and the District of Columbia in 2015-2016 compared to 2013-2014. Alaska, Idaho, Nevada, Oregon, and Tennessee saw the greatest improvement—a five-to-six-point reduction.

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