Remember that headline-grabbing report last week that said Kansas was the only state in the nation to see a significant increase in its uninsured rate?
Well, it’s looking more and more suspect.
Some officials were immediately skeptical when the Gallup-Healthways Well-Being Index survey results were released, showing that the adult uninsured rate in Kansas had increased by 5.1 percentage points, jumping from 12.5 percent in 2013 to 17.6 percent by mid-year 2014.
Kansas Insurance Commissioner Sandy Praeger was among the doubters. She said the number appeared to be “an anomaly” because a spike of that magnitude from one year to the next “would be unprecedented.”
But others seized on the numbers to score political points. Some said Kansas’ decision to join 23 other states in not expanding Medicaid contributed to the increase. Others said the number was evidence that the Affordable Care Act was failing to achieve its primary goal of reducing the number of uninsured – if only in Kansas.
But upon closer inspection, neither contention appears to be the case.
Increases not decreases
Even though Kansas didn’t expand Medicaid eligibility, enrollment is up significantly over last year because of something known as the woodwork effect. Increased attention to health insurance issues, due to the ACA, has caught the attention of people who already were eligible for the program and prompted them to enroll.
Approximately 426,000 Kansans are enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) — together known as KanCare, the state’s managed care program — up from just under 399,000 in July 2013, according to state officials. About half of Kansas Medicaid enrollees are children, including more than 56,000 in CHIP.
“Since Medicaid enrollment is increasing at a steady pace, if there is an increase in the number of uninsured it would have to be driven by other factors,” said Kari Bruffett, secretary of the Kansas Department of Aging and Disability Services. Bruffett previously oversaw KanCare as director of the Health Care Finance Division at the Kansas Department of Health and Environment.
If Medicaid enrollment is up, only a sharp drop in the number of Kansans with private coverage could explain the reported increase in the uninsured rate. But there has been no such drop, said Mary Beth Chambers, a spokesperson for Blue Cross Blue Shield of Kansas, the state’s largest health insurer.
“With all due respect to the researchers, our enrollment numbers in both our group and individual lines of business have grown in the first six months of 2014,” Chambers said in an email to KHI News Service. “Based on our numbers, and figures we have seen in various other reports, we would have anticipated a decrease in the uninsured rate for Kansas.”
That leaves some sort of methodological or sampling error as the most likely explanation, said Scott Brunner, a senior analyst at the Kansas Health Institute, a nonpartisan policy and research organization that also houses the editorially independent KHI News Service.
Brunner said the Gallup results “look more like a statistical anomaly than anything that’s actually happening.”
When KHI analysts sought an explanation from Gallup researchers, they also were scratching their heads, Brunner said.
“It puzzled them as well,” he said. “They didn’t have a good explanation for why Kansas would be so different.”
The uninsured rate reported by Gallup was based on a single question in a survey designed to measure several indicators of health and well-being. The sampling error for the 2013 survey ranged to as high as 3.5 points for smaller population states. For the midyear 2014 results, the error range was as high as plus or minus 5 points for the smaller states.
An annual survey conducted by the U.S. Census Bureau includes a more extensive battery of health insurance questions and produces what most researchers and government agencies consider a more authoritative estimate.
But lag time is a problem. The latest survey available, for 2012, shows that 12.6 percent of Kansans were uninsured. The extent to which the ACA and Medicaid expansion have reduced that rate won’t start to be reflected in the Census Bureau data until 2015.
Expansion states doing better
In the meantime, one thing does seem clear from recent surveys: The biggest reductions in uninsured rates have occurred in states that expanded Medicaid and played a role in establishing their online insurance marketplaces.
That was the conclusion of the Gallup survey and one conducted recently by the Urban Institute, a nonpartisan research organization in Washington, D.C.
The report detailing the Urban Institute’s findings said: “The uninsurance rate for adults in the states that adopted the ACA’s Medicaid expansion dropped 6.1 percentage points since September 2013, compared with a drop of 1.7 percentage points for the nonexpansion states. This represents a decline in the uninsurance rate of 37.7 percent in the expansion states, as compared to only 9 percent in the nonexpansion states.”
In Kansas, Medicaid enrollment has increased in the last year by about 25,000. That number is dwarfed by the estimated 151,000 adult Kansans who would be likely to enroll under expansion.
Currently in Kansas, able-bodied adults without children can’t qualify for Medicaid. Adults with children are eligible only if they earn less than 32 percent of the poverty level annually — about $3,730 for an individual and $7,630 for a family of four.
Expansion would make all Kansas adults earning up to 138 percent of the poverty level — annually about $16,100 for an individual and $32,900 for a family of four — eligible for the health care program.
Jim McLean is executive editor of KHI News Service, an editorially independent reporting program of the Kansas Health Institute.