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Regulation and Compliance > State Regulation

Uninsured rate drops sharply in some swing states

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The candidates who are running for president in 2016 will test whether the Patient Protection and Affordable Care Act of 2010 (PPACA) health coverage expansion programs have had any noticeable effect on the electorate.

See also: Survey: Higher-income consumers less happy with PPACA plans

Dan Witters, an analyst at Gallup, has raised questions about the impact of the PPACA-related effects on uninsured rates by releasing a state-by-state analysis of how the uninsured rates measured by their surveys changed between 2013, before major PPACA coverage expansion programs took effect, and the first half of 2015.

PPACA watchers are debating how stable the coverage expansion programs, and the current effects of the programs, will be.

At this point, Witters says, the effects are obvious. He found a drop in the uninsured rate in every state but Wyoming, and the apparent increase there — to 18.2 percent, from 16.6 percent — is based on a very small sample and is not statistically significant.

See also: PPACA’s popularity scares Republicans, witness says

The uninsured rate dropped to an average of 8.9 percent of the total state population, from 16 percent, in the states that adopted both the PPACA Medicaid expansion program and the PPACA public exchange program.

The rate dropped to an average of 13.4 percent, from 18.7 percent, in the other states.

Another way to look at those shifts is that 7.1 percent of the residents of the states that adopted both types of PPACA coverage expansion programs, and 5.3 percent of the residents of the other states, now have health coverage tied to PPACA coverage expansion programs.

See also: Hospital chains can’t move home-state Republicans on PPACA

Political analysts at the University of Virginia Center for Politics have put up a separate collection of data showing how many votes each state will have in the Electoral College in 2016; how those states voted in the 2012 presidential elections; and whether those states appear to be swing states.

States and the District of Columbia will have a total of 538 Electoral College votes in 2016. 

In seven states that have 9 or more Electoral College votes and are rated as either toss-up states or states that lean Republican, the decreases in the state uninsured rate ranged from a drop of 0.8 percentage points (to 12.5 percent, in Virginia) up to a drop of 7.8 percent (to 6.1 percent, in Ohio). Virginia is the only state on the list in which the drop has been less than 3 percentage points. 

See also: Trump, Kasich face PPACA screening tests

The size of the drop in a state’s uninsured rate is bigger than that state’s 2012 presidential election victory margin in four of the states: Colorado, Florida, North Carolina and Ohio. 

The size of the drop in the state uninsured rate also seems to be comparable to the size of the 2012 presidential election margin of victory in some other large states that the University of Virginia analysts identify as being likely to vote for the Republican presidential nominee in 2016. In Georgia, for example, the uninsured rate dropped 6.1 percentage points, to 15.3 percent, this year. Mitt Romney’s margin of victory against Obama in 2012 was 7.8 percentage points.

One question will be whether efforts to get states’ uninsured residents engaged with health insurance programs, and equipped with identification documents suitable for applying for public health programs, will have any effect on whether those newly insured residents’ are registered to vote, or whether they actually vote. Another question will be how much they think about their health coverage when casting their votes.

Exchange users did not have an obvious affect on the results of the 2014 midterm elections, but enrollment was considerably lower than it is now, and, at that point, some exchange plan users had still not used their coverage. It’s also possible that any new voters coming into the electorate from the exchange program might be more likely to start out voting in a presidential election than in other, somewhat less-discussed elections.

Swing state 2015 uninsured rate

Drop in uninsured rate (2013 vs. 2015)

(In percentage points)

2012 presidential winner

2012 victory margin

(In percentage points)

Electoral votes
Colorado 10.6% 6.4 Obama 5.4 9
Florida 15.2% 6.9 Obama 3 29
North Carolina 14.7% 5.7 Romney 2 15
Ohio 6.1% 7.8 Obama 3 18
Pennsylvania 7.7% 3.3 Obama 5.4 20
Virginia 12.5% 0.8 Obama 3.9 13
Wisconsin 5.6% 6.1 Obama 6.9 10
TOTAL         114
Sources: Gallup; University of Virginia Center for Politics


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