Expanded coverage under the federal health law apparently drove a significant decline in the number of uninsured children in Minnesota, a new report finds, with the state’s coverage gains for kids outpacing those in most other states.
The number of Minnesota children lacking coverage fell from about 86,000 in 2013 to fewer than 48,000 in 2014, according to the report being released Thursday from researchers at the University of Minnesota.
Nationally, the uninsured rate among children age 0 to 18 fell from 7.5 percent in 2013 to 6.3 percent in 2014, with Minnesota’s rate falling from 6.3 percent to 3.5 percent.
Declines were expected since the federal Affordable Care Act in 2014 expanded public health insurance coverage and provided tax credits to many buying private coverage. But the magnitude of coverage gains in Minnesota was surprising, researchers said, and noteworthy because the benefit was concentrated among low-income and nonwhite residents.
“This drop from 2013 to 2014 is really historic,” said Elizabeth Lukanen, a public health researcher at the U. “We feel pretty confident that we can attribute these gains to the Affordable Care Act.”
The new report can’t prove a link between coverage gains and the health law, but Lukanen said the link seems particularly strong in Minnesota where the state opted to expand eligibility in public insurance programs. The state also created the MNsure health insurance exchange, she said, which heavily advertised coverage options for 2014 and coordinated a statewide network of health insurance counselors.
Coverage for children’s health care needs is becoming more important as the cost of care continues to rise, and studies show links between better health outcomes and insurance coverage.
“It’s likely the case that more children gained coverage as eligible parents signed up for free or low-cost health insurance, and we’re likely to see that trend continue,” said Lynn Blewett, director of a research center at the U that compiled the report, in a statement.
Overall, the numbers in the report are encouraging, particularly for the gains seen in coverage for low-income children in the state, said Liz Doyle, associate director of TakeAction Minnesota, a policy group that supported Minnesota’s efforts to implement the Affordable Care Act.
At the Minnesota Council of Health Plans, Jim Schowalter credited community groups and county workers who “do the hard work of helping Minnesotans figure out what they qualify for,” said the trade group’s chief executive in a statement.
But Peter Nelson, a vice president with the conservative Center of the American Experiment in Golden Valley, questioned whether those with public insurance in 2014 actually qualified for the coverage.
A January report from Legislative Auditor James Nobles that suggested 28 percent of people with public coverage in early 2015 didn’t qualify, and Nelson suggested there likely were more problems with eligibility determinations in 2014.
“If nearly 30 percent weren’t eligible, that’s a big number and that could easily influence the state’s uninsured rate,” Nelson said.
Funded by the Robert Wood Johnson Foundation, the new report is the latest in a series based on U.S. Census Bureau data that found a stable or decreasing uninsured rate for children between 2010 and 2013.
The nationwide 1.2 percentage point drop in the rate from 2013 to 2014, however, is the largest year-over-year decrease since the census added certain information about health insurance in 2008, according to the report.
Between 2013 and 2014, Minnesota was one of 23 states that saw a significant decrease in children lacking coverage. No state saw a significant increase, researchers said.
Minnesota saw the second largest percentage-point decline (2.8), behind Nevada’s drop of 4.4 percentage points. In terms of the number of uninsured children, Minnesota saw the fifth largest decline.
Dropping 38,000 kids from the ranks of the uninsured between 2013 and 2014 puts Minnesota “among the top five states, which is typically dominated by states with just really large populations,” Lukanen said. “We were all surprised to see it on both of those top-five lists.”
Improvements were particularly strong among nonwhite children, who saw a 5.9 percentage point decline in their uninsured rate, to 3.4 percent in 2014, according to the report. The rate of uninsured children in households with income near or below the poverty level declined to 5.8 percent, a drop of 4.6 percentage points.
“There was a significant impact on a group of children that’s historically had low rates of coverage — that’s nonwhite kids and low-income kids,” Lukanen said. “They’re more on parity with their white counterparts.”
Historically, Minnesota has been among the leaders nationally in the share of children covered by private health insurance. Public health insurance rates for kids in the state have lagged, Lukanen said, even though Minnesota has generous benefits for children through state public programs.
It’s not clear from the new report whether the gains in 2014 were driven more by private or public health insurance, although Lukanen expects that future reports will find public coverage is the driver.
In 2014, Lukanen and colleagues at the U’s State Health Access Data Assistance Center reported the state’s uninsured rate across all populations fell from 8.2 percent in 2013 to 4.9 percent in 2014 — the lowest rate ever recorded for the state. The earlier report suggested that much of the coverage gains in Minnesota came from state public programs, Lukanen said.
It’s possible that some gains in coverage between 2013 and 2014 were a function of a stronger economy in some states, she said, as opposed to the Affordable Care Act. But Lukanen added: “Even when we’ve seen improvements in the economy in years past, we have not seen coverage gains that are this large.”