The Uninsured in Virginia: An Update

Genevieve M. Kenney

The Urban Institute

jkenney@urban.org

@kenneygm

Source Material

• Huntress M, GM Kenney, and N Anderson. “Profile of Virginia’s Uninsured, 2012.” The Urban Institute.– Huntress M and GM Kenney. “Profile of Virginia’s Uninsured, 2011.” The Urban Institute,

October 2013. http://www.vhcf.org/wp-content/uploads/2010/10/Uninsurance-in-Virginia-for-VHCF-with-tables-and-maps-FINAL-10-7-13.pdf

– Macri J, V Lynch, and GM Kenney. “Profile of Virginia’s Uninsured, 2010.” The Urban Institute, March 2012. http://www.vhcf.org/wp-content/uploads/2010/10/VHCF-Profile-of-the-Uninsured-Final.pdf

• Buettgens M, GM Kenney, and H Recht. “Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States: May 2014 Update.” The Urban Institute, May 2014. http://www.urban.org/UploadedPDF/413129-Eligibility-for-Assistance-and-Projected-Changes-in-Coverage-Under-the-ACA-Variation-Across-States.pdf

• Blumberg LJ, J Holahan, GM Kenney, M Buettgens, N Anderson, H Recht, and S Zuckerman. “Measuring Marketplace Enrollment Relative to Enrollment Projections: Update.” The Urban Institute, May 2014. http://www.urban.org/UploadedPDF/413112-Measuring-Marketplace-Enrollment-Relative-to-Enrollment-Projections-Update.pdf

Main Takeaways• Number of Uninsured in VA is about one million• Uninsured rates in VA are typically lower than in

the nation as a whole, but difference narrowed between 2008-2012

• Most Uninsured Virginians are adults• Just under half are white, non-Hispanic (47.1%)• The majority are in working families• Uninsured rates are higher in Southern and

Western parts of the state

Main Takeaways (2)

• Uninsured adults in VA are much more likely than insured adults to have unmet needs and less likely to receive preventive services, even when controlling for observed differences between the two groups

• An estimated 362,000 uninsured adults could qualify for coverage under the Medicaid expansion– Could further lower uninsured rate in VA by 5.2

percentage points

Almost 1 million Virginians lack health insurance coverage, 89 percent of whom are adults

Total Nonelderly

995,000 uninsured nonelderly

Source: Urban Institute, April 2014. Based on the 2012 American Community Survey (ACS) data from the Integrated Public Use Microdata Series (IPUMS). The estimates reflect Urban Institute adjustments for potential misreporting of coverage, based on a simulation model developed by Victoria Lynch under a grant from the Robert Wood Johnson Foundation.

Nonelderly Uninsured

886,000 uninsured nonelderly adults

17.8%

14.3%

5.5%

0%

4%

8%

12%

16%

20%

Children Adults Nonelderly

% U

nin

su

red

Adults are 3.2 times more likely to be uninsured than children in Virginia

Source: Urban Institute, April 2014. Based on the 2012 American Community Survey (ACS) data from the Integrated Public Use Microdata Series (IPUMS). The estimates reflect Urban Institute adjustments for potential misreporting of coverage, based on a simulation model developed by Victoria Lynch under a grant from the Robert Wood Johnson Foundation.

Uninsurance among the nonelderly was lower in VA than the United States a whole, during 2008-2012

2008 2009 2010 2011 201210%

11%

12%

13%

14%

15%

16%

17%

18%

19%

13.2%

14.3%

16.8% 17.1%

#

* #

United States

Virginia

3.6 percentagepoint difference

2.8 percentagepoint difference

Note: Asterisks indicate the 2011 uninsured rate is statistically different from 2012 at the .10 level. Hash tags indicate the 2008 uninsured rate is statistically different from 2012 at the .10 level.

Source: Urban Institute, April 2014. Based on the 2008, 2009, 2010, 2011 and 2012 American Community Survey (ACS) data from the Integrated Public Use Microdata Series (IPUMS). The estimates reflect Urban Institute adjustments for potential misreporting of coverage, based on a simulation model developed by Victoria Lynch under a grant from the Robert Wood Johnson Foundation.

Uninsurance in Virginia increased among adults and decreased among children between 2008 and 2012 but

remained steady between 2011 and 2012

Note: Asterisks indicate the 2011 uninsured rate is statistically different from 2012 at the .10 level. Hash tags indicate the 2008 uninsured rate is statistically different from 2012 at the .10 level.

Source: Urban Institute, April 2014. Based on the 2008, 2009, 2010, 2011 and 2012 American Community Survey (ACS) data from the Integrated Public Use Microdata Series (IPUMS). The estimates reflect Urban Institute adjustments for potential misreporting of coverage, based on a simulation model developed by Victoria Lynch under a grant from the Robert Wood Johnson Foundation.

2008 2009 2010 2011 20120.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

13.2%14.3%

7.2%5.5%

15.8%

17.8%

#

#

#Adults

Total Nonelderly

Children

Over forty percent of all uninsured Virginians live below the poverty level

Notes: Family poverty level estimates are based on health insurance unit gross income and use the 2012 Federal Poverty Levels (FPLs) defined by the U.S. Census Bureau. Estimates may not sum to 100% due to rounding.

Source: Urban Institute, April 2014. Based on the 2012 American Community Survey (ACS) data from the Integrated Public Use Microdata Series (IPUMS). The estimates reflect Urban Institute adjustments for potential misreporting of coverage, based on a simulation model developed by Victoria Lynch under a grant from the Robert Wood Johnson Foundation.

65.4%69.4%68.6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Total Nonelderly Children Adults

% o

f to

tal

un

ins

ure

d

Over two-thirds of Virginians who are uninsured live in families with income at or below 200 percent of the

FPL

Individuals at or below 200% Federal Poverty Level

Notes: Family poverty level estimates are based on health insurance unit gross income and use the 2012 Federal Poverty Levels (FPLs) defined by the U.S. Census Bureau. Estimates may not sum to 100% due to rounding.

Source: Urban Institute, April 2014. Based on the 2012 American Community Survey (ACS) data from the Integrated Public Use Microdata Series (IPUMS). The estimates reflect Urban Institute adjustments for potential misreporting of coverage, based on a simulation model developed by Victoria Lynch under a grant from the Robert Wood Johnson Foundation.

Virginians living below poverty are over 11 times more likely to be uninsured as Virginians living at or above 401 percent

of FPL

Total Nonelderly

Notes: Family poverty level estimates are based on health insurance unit gross income and use the 2012 Federal Poverty Levels (FPLs) defined by the U.S. Census Bureau.

Source: Urban Institute, April 2014. Based on the 2012 American Community Survey (ACS) data from the Integrated Public Use Microdata Series (IPUMS). The estimates reflect Urban Institute adjustments for potential misreporting of coverage, based on a simulation model developed by Victoria Lynch under a grant from the Robert Wood Johnson Foundation.

Over 70 percent of uninsured Virginians live in families with at least one full or part-time worker

Share of Nonelderly Uninsured

Notes: Family work status is based on the work status of the head or spouse of the health insurance unit. Estimates may not sum to 100% due to rounding.

Source: Urban Institute, April 2014. Based on the 2012 American Community Survey (ACS) data from the Integrated Public Use Microdata Series (IPUMS). The estimates reflect Urban Institute adjustments for potential misreporting of coverage, based on a simulation model developed by Victoria Lynch under a grant from the Robert Wood Johnson Foundation.

Full-time workers and their families make up 48.6 percent of the uninsured in Virginia and are distributed

over all income levels

Notes: Family poverty level estimates are based on health insurance unit gross income and use the 2012 Federal Poverty Levels (FPLs) defined by the U.S. Census Bureau. Family work status is based on the highest level of employment among the adults in the health insurance unit. Estimates may not sum to 100% due to rounding.

Source: Urban Institute, April 2014. Based on the 2012 American Community Survey (ACS) data from the Integrated Public Use Microdata Series (IPUMS). The estimates reflect Urban Institute adjustments for potential misreporting of coverage, based on a simulation model developed by Victoria Lynch under a grant from the Robert Wood Johnson Foundation.

$23,492 for a family of four

$32,419 for a family of four

$46,984 for a family of four

$70,476 for a family of four

$93,968 for a family of four

White, 47.1%

Hispanic, 19.2%

Other/ Mul-tiple,2.6%

Asian/ Pa-cific Islander,

8.1%

Black or African

American, 23.0%

Just under half of the uninsured in Virginia are white, non-Hispanic

Share of Nonelderly Uninsured

Notes: Estimates may not sum to 100% due to rounding.

Source: Urban Institute, April 2014. Based on the 2012 American Community Survey (ACS) data from the Integrated Public Use Microdata Series (IPUMS). The estimates reflect Urban Institute adjustments for potential misreporting of coverage, based on a simulation model developed by Victoria Lynch under a grant from the Robert Wood Johnson Foundation.

20.8% 21.7%

79.2% 78.3%86.9%

13.1%

0%

25%

50%

75%

100%

TotalNonelderly

Children Adults

% o

f to

tal

un

ins

ure

d

NoncitizenU.S. Citizen

Nearly four-fifths of the uninsured in Virginia are U.S. citizens

Share of Nonelderly Uninsured

Notes: Estimates may not sum to 100% due to rounding.

Source: Urban Institute, April 2014. Based on the 2012 American Community Survey (ACS) data from the Integrated Public Use Microdata Series (IPUMS). The estimates reflect Urban Institute adjustments for potential misreporting of coverage, based on a simulation model developed by Victoria Lynch under a grant from the Robert Wood Johnson Foundation.

22.3%24.6%

26.3%27.6%

25.8%

0%

5%

10%

15%

20%

25%

30%

2008 2009 2010 2011 2012

% U

nin

su

red

Uninsurance declined for young adults (19-26) in Virginia between both 2008 and 2012, and 2011 and 2012

Note: Asterisks indicate the 2011 uninsured rate is statistically different from 2012 at the .10 level. Hash tags indicate the 2008 uninsured rate is statistically different from 2012 at the .10 level.

Source: Urban Institute, April 2014. Based on the 2008, 2009, 2010, 2011 and 2012 American Community Survey (ACS) data from the Integrated Public Use Microdata Series (IPUMS). The estimates reflect Urban Institute adjustments for potential misreporting of coverage, based on a simulation model developed by Victoria Lynch under a grant from the Robert Wood Johnson Foundation.

* #

Unmet Needs Due

to Cost

Regular Provider

Routine Checkup

Flu Shot Dental Visit0%

20%

40%

60%

80%

100%

9.0%

83.9%77.6%

46.1%

75.3%

49.2%* 43.8%* 44.8%*

23.1%*

43.5%

Insured

Uninsured

Uninsured adults in Virginia are more likely than insured adults to have unmet needs and less likely to receive pre-

ventive care

Note: Adults are age 19-64. Measures refer to access or utilization over the past 12 months. Estimates marked with * indicate the difference between the insured and uninsured estimates is significant at the .01 percent level.

Source: Urban Institute, April 2014. Based on the 2012 Behavioral Risk Factor Surveillance System.

Unmet Needs Due

to Cost

Regular Provider

Routine Checkup

Flu Shot

Dental Visit

0% 20% 40% 60%

40.2%*

40.0%*

32.8%*

23.0%*

31.8%*

35.2%*

34.7%*

27.5%*

17.9%*

28.2%*

Unadjusted Difference Between Insured and Uninsured

Adjusted Difference Between Insured and Uninsured

Differences in healthcare between insured and uninsured adults in Virginia even when controlling for socio-demo-

graphic characteristics

Note: Adults are age 19-64. Measures refer to access or utilization over the past 12 months. Estimates marked with * indicate the difference between the insured and uninsured estimates is significant at the .01 percent level. Adjusted differences use a linear model controlling for age, sex, race, and health status.

Source: Urban Institute, April 2014. Based on the 2012 Behavioral Risk Factor Surveillance System.

Medicaid Expansion Under the ACA

• 240,000 uninsured Virginians below 100% of FPL would become eligible for public coverage should Virginia expand Medicaid– 46.5% of these are between the ages of 19-34

• An additional 122,000 uninsured have incomes below 138% of FPL and would also become eligible for public coverage should Virginia expand Medicaid

• In all, about 362,000 uninsured Virginians are affected by the Medicaid expansion decision

Marketplace Enrollment as of April 19, 2014 Compared to Projected 2014 Enr...0%

20%

40%

60%

80%

100%

120%123.9%

115.3%

Virginia

US

Marketplace Enrollment Progress in Virginia Compared to the Nation

Blumberg LJ, J Holahan, GM Kenney, M Buettgens, N Anderson, H Recht, and S Zuckerman. “Measuring Marketplace Enrollment Relative to Enrollment Projections: Update.” The Urban Institute, May 2014. http://www.urban.org/UploadedPDF/413112-Measuring-Marketplace-Enrollment-Relative-to-Enrollment-Projections-Update.pdf

Percent Change0%

2%

4%

6%

8%

10%

4.5%

3.3%

Virginia

Non-Expansion States

Percent Change in July-September 2013 Medicaid Enroll-ment to April 2014 Medicaid Enrollment

“Medicaid & CHIP: April 2014 Monthly Applications, Eligibility Determinations, and Enrollment Report” Center for Medicare and Medicaid Services, 4 June 2014, http://www.medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Downloads/April-2014-Enrollment-Report.pdf