Health Care Insurance

The Affordable Care Act (ACA) was designed to decrease the number of uninsured across the nation and improve the ability of all citizens to access quality health care. The ACA relies on two strategies to reduce the number of uninsured:

• Provide state health insurance exchanges that allow individuals to purchase health insurance across a spectrum of coverage and price options, and provide subsidies to make these policies affordable to those with lower incomes.
• Extend eligibility coverage for Medicaid to those who are below or nearly below the federal poverty level. Due to a U.S. Supreme Court decision, this extension of eligibility was made a state option.

Both Missouri and Kansas opted not to create state exchanges, instead allowing residents to enroll for coverage through the federal health insurance marketplace. As of the publication of this report, neither state has opted to extend Medicaid eligibility.

The impact of the ACA is documented in recent data from the Census Bureau's American Community Survey. The chart below shows uninsurance rates from 1-year ACS data, 2009-2016. (Note: counties with populations below 65,000 are not included in 1-year ACS data prior to 2014, and no 1-year data is available for counties below 20,000 population.) Enrollment in the ACA-authorized Federal Health Care Marketplace began in October 2013, with plan coverage beginning January 2014.

 

 

During the five years prior to ACA coverage beginning, the percentage of residents without health insurance held stable at just over 13 percent. Individual counties showed more fluctuation but little discernable trend except for Platte County, which saw its uninsurance rate rise from 6 percent to nearly 10 percent. Since the passage of the ACA, all counties experienced a significant drop in the percentage of residents without health insurance. As a result, the metro uninsurance rate dropped nearly 5 percentage points, from 13. 2 percent in 2013 to 8.4 percent in 2016.

Of some concern, however, is that, between 2015 and 2016, all of the Kansas counties experienced small increases in their uninsurance rates. These increases are well within the margins of error of the estimates and so are not statistically significant. However, the uniformity of the pattern is worrisome.

By contrast, nearly all Missouri counties saw a decline in the proportion of people who were uninsured between 2015 and 2016, some substantially. For example, Clay saw a 2.2 percent reduction in the last year, and Platte saw a 2.9 percent reduction. In both cases, however, this was after almost no reduction the prior year.

 

 

Because of the year-to-year fluctuations in the data, a more definitive picture emerges by examining the average rates of uninsurance pre- and post-passage of the ACA. Though Wyandotte County has the highest percentage of residents without health insurance, at 19.4 percent in 2016, this is more than a 5 percentage point reduction since 2013. Leavenworth County shows the lowest rate of uninsurance among its residents, at 4.4 percent in 2016, which is less than half its 2013 value of 9.3 percent.

 

Taking the difference between the pre- and post-ACA averages provides an estimate of the average increase in health care coverage in each county and the metro as a result of passing the ACA. On average, the share of residents that have health insurance has increased by nearly 4 percentage points. Three counties saw increases in the share of residents covered by health insurance that were greater than 4 percent, led by Wyandotte with 5.1 percent increase, Leavenworth with a 4.9 percent increase, and Jackson with a 4.8 percent increases. Two counties experienced health care coverage improvements just under the regional average, Johnson and Cass with coverage rates that increased 3.4 percent and 3.5 percent respectively. Northland counties saw improvements to health care coverage that were somewhat smaller than those for the region overall, with Clay showing an average increase of 2.6 percent and Platte an average increase of 1.2 percent.

Perhaps more impressive than the reductions in uninsurance rates are the actual reductions of the number of people without health insurance. The number of residents of the Kansas City metropolitan area who are uninsured held fairly steady in the years leading up to ACA enrollment and, in 2013, numbered nearly 267,000. By 2016, that figure had dropped to about 174,000, a 93,000 reduction.

 

Not surprisingly, the largest counties with the greatest number of uninsured residents also saw the largest reductions in their numbers. The ranks of the uninsured declined most in Jackson County, by about 39,000, followed by Johnson County where the number of uninsured declined by 18,000. In Clay County, nearly 10,000 fewer residents were without health insurance than before ACA enrollment began, while in Wyandotte County, there was a 9,000 reduction in the number of residents without health insurance coverage. Leavenworth, Cass and Platte Counties all experienced a decline in the uninsured of about 4,000.