Strategic Planning & Timelines

Dollars spent on health care are dollars not available for other uses. Understanding the rate at which costs are growing—and the growth rate the economy can bear—is important for the financial health of any state. This report looks at total cost of care measurement activities in four states and the policy priorities in each state that are driving the activity. It examines the questions these states had to ask and in determining total cost of care measurement—where data come from, what to count, how to count—and how they answered them.

Since the ACA’s health insurance marketplaces opened and states began to expand Medicaid eligibility, uninsured rates among Latinos have begun to decline for the first time in decades. Studies of the effects of health insurance suggest that these higher coverage rates will contribute to better access to care, increased use of preventive services, better management of chronic illness and, eventually, longer and healthier lives for many Latinos. Despite these historic declines in the number of uninsured, the Commonwealth Fund Biennial Health Insurance Survey finds Latinos continue to have the highest uninsured rates among major U.S. racial or ethnic groups.

Since the ACA’s first open enrollment period began in late 2013, there has been rapid enrollment growth in Medicaid and in private health insurance plans purchased through the new Marketplaces. However, administrative data on Medicaid enrollment and enrollment in Marketplace health plans do not show how health insurance coverage is changing under the ACA, because not all of those enrolling were previously uninsured. Household survey data are needed to track changes over time in the share of the population that is uninsured. This report uses the Urban Institute’s Health Reform Monitoring Survey (HRMS) to examine trends in health insurance coverage since the first quarter of 2013. According to HRMS data, the uninsurance rate among nonelderly adults has declined 7.5 percentage points between September 2013 and March 2015, representing 15 million fewer adults without health insurance.

Since the Great Recession peaked in 2010, the economic picture has steadily improved, and in 2013, GDP increased relative to 2012 and the unemployment rate fell but remained fairly high at 7.4 percent. In addition, the uninsured rate decreased slightly (0.1 percentage point) in 2013, continuing the trend from 2011 and 2012. Despite these improvements, rates of coverage through employer sponsored insurance have declined since 2010, though more slowly in recent years than at the height of the recession. Gains in coverage since 2010 have been largely due to increases in coverage through public programs such as Medicaid and the Children’s Health Insurance Program (CHIP). This brief further examines coverage patterns for the nonelderly population from 2008 through 2013 using data from the American Community Survey.

Across the country’s four largest states, uninsured rates vary for adults ages 19 to 64: 12 percent of New Yorkers, 17 percent of Californians, 21 percent of Floridians, and 30 percent of Texans lacked health coverage in 2014. Differences also extend to the proportion of residents reporting problems getting needed care because of cost, which was significantly lower in New York and California compared with Florida and Texas. These differences stem from a variety of factors, including whether states have expanded eligibility for Medicaid, the state’s uninsured rate prior to the Affordable Care Act taking effect, differences in the cost protections provided by private health insurance, and demographics.