The Uninsured in Virginia: An Update Nathaniel Anderson, Laura Skopec, and Genevieve M. Kenney The Urban Institute

The Uninsured in Virginia: An Update

Nathaniel Anderson, Laura Skopec, and Genevieve M. Kenney

The Urban Institute

Source MaterialHuntress M, GM Kenney, and N Anderson. “Profile of Virginia’s Uninsured,

2012.” The Urban Institute. April 2014. http://www.vhcf.org/wp-content/uploads/2010/10/2014-Profile-of-Virginias-Uninsured.pdf.

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

http://www.vhcf.org/wp-content/uploads/2010/10/2014-Profile-of-Virginias-Uninsured.pdf



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




http://www.vhcf.org/wp-content/uploads/2010/10/VHCF-Profile-of-the-Uninsured-Final.pdf



http://www.urban.org/UploadedPDF/413129-Eligibility-for-Assistance-and-Projected-Changes-in-Coverage-Under-the-ACA-Variation-Across-States.pdf



http://www.urban.org/UploadedPDF/413112-Measuring-Marketplace-Enrollment-Relative-to-Enrollment-Projections-Update.pdf

http://www.urban.org/UploadedPDF/413112-Measuring-Marketplace-Enrollment-Relative-to-Enrollment-Projections-Update.pdf

Methods

• All data are from the 2013 American Community Survey (ACS) and therefore reflect uninsurance in Virginia prior to the first open enrollment period for the health insurance Marketplaces.

• The family structures and corresponding income estimates used in this analysis are based on Health Insurance Units (HIUs), or groups of individuals who would likely be considered a family unit for the purposes of eligibility for Medicaid or the Marketplaces. HIUs are generally smaller than Census-reported families, and their income is generally lower than the Census estimates of family-based income.

• Therefore, more Virginians fall below the Federal Poverty Level (FPL) when estimates are based on HIU income than would be the case if estimates were based on Census-reported family income.

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 2008-2013

• 69.5 percent of uninsured Virginians (684,000) live in families with income at or below 200 percent of the Federal Poverty Level (FPL)

• Most uninsured Virginians are adults; the majority are white and 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 366,000 adults with incomes below 138 percent of the Federal Poverty Level (FPL) could qualify for coverage under the Medicaid expansion

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

Total Nonelderly

997,000 uninsured nonelderlySource: Urban Institute, May 2015. Based on the 2013 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

888,000 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, May 2015. Based on the 2013 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 as a whole, during 2008-2013

2008 2009 2010 2011 2012 201310%

11%

12%

13%

14%

15%

16%

17%

18%

19%

13.2%

14.3%

16.8% 16.9%

#

* #

United States

Virginia

3.6 percentagepoint difference

2.6 percentagepoint difference

Note: * indicates the 2012 uninsured rate is statistically different from 2013 at the .10 level. # indicates the 2008 uninsured rate is statistically different from 2013 at the .10 level.

Source: Urban Institute, May 2015. Based on the 2008, 2009, 2010, 2011, 2012, and 2013 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 2013 but remained steady between 2012 and 2013

Note: * indicates the 2012 uninsured rate is statistically different from 2013 at the .10 level. # indicates the 2008 uninsured rate is statistically different from 2013 at the .10 level.


2008 2009 2010 2011 2012 20130.0%

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

42.1%32.1%

43.3%

11.2%

9.0%

11.4%

16.2%

17.5%

16.0%

15.7%

19.4%

15.2%

6.7%10.8%

6.2%8.2% 11.2% 7.8%

0%

25%

50%

75%

100%

Total Nonelderly Children Adults

% o

f to

tal

un

ins

ure

d

401+% FPL

301-400% FPL

201-300% FPL

139-200% FPL

100-138% FPL

<100% FPL

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 2013 Federal Poverty Levels (FPLs) defined by the U.S. Census Bureau. Estimates may not sum to 100% due to rounding.


58.6%

70.8%69.5%

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

FPLIndividuals at or below 200%

Federal Poverty Level

Notes: Family poverty level estimates are based on health insurance unit gross income and use the 2013 Federal Poverty Levels (FPLs) defined by the U.S. Census Bureau. Estimates may not sum to 100% due to rounding.


Virginians living below poverty are over 10 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 2013 Federal Poverty Levels (FPLs) defined by the U.S. Census Bureau.


<100% 100-138% 139-200% 201-300% 301-400% 401+% 0%

5%

10%

15%

20%

25%

30%

35%30.7%

26.1%24.0%

16.3%

8.1%

3.0%

Family Federal Poverty Level (FPL)

% U

nins

ured

Only part-time

worker(s); 22.4%

Two full time

workers; 6.3%

One full-time worker; 44.2%

Child Not Living with

Parents; 0.8%

No working adults; 26.3%

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.


Full-Time Workers and Their...0%

25%

50%

75%

100%

16.8%

12.1%

22.5%

24.5%

10.8%

13.3%

401+% FPL 301-400% FPL 201-300% FPL 139-200% FPL 100-138% FPL <100% FPL

% o

f to

tal

un

ins

ure

dFull-time workers and their families make up 50.5

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 2013 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.


$23,550 for a family of four





White, 46.0%

Hispanic, 21.6%

Other/ Mul-tiple,2.8%

Asian/ Pacific Is-

lander, 6.9%

Black or African

American, 22.8%

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


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


20.3% 21.3%

79.7% 78.7%87.4%

12.6%

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


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


22.3% 22.2%24.6%

26.3%27.6%

25.8%

0%

5%

10%

15%

20%

25%

30%

2008 2009 2010 2011 2012 2013

% U

nin

su

red

Uninsurance declined for young adults (19-26) in Virginia between both 2008 and 2013, and between 2010

and 2013

Note: # indicates the 2008 uninsured rate is statistically different from 2013 at the .10 level.


#

Regular Provider

Routine Checkup

Flu Shot Unmet Needs Due

to Cost

Depressive Disorder

Not Good Mental Health (Days)

0%

20%

40%

60%

80%

100%

79.7%74.2%

43.2%

10.1%15.9%

3.2

41.6%*44.8%*

19.4%*

51.6%*

22.1%*

5.1*

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, June 2015. Based on the 2013 Behavioral Risk Factor Surveillance System.

Unmet Needs Due to Cost

Regular Provider

Routine Checkup

Flu Shot

Depressive Disorder

Not Good Mental Health (Days)

0% 20% 40% 60%

41.5%*

38.1%*

29.4%*

23.8%*

6.2%*

1.9*

35.1%*

34.2%*

29.0%*

19.9%*

5.0%*

1.1*

Adjusted Difference Between Insured and UninsuredUnadjusted Difference Between Insured and Uninsured

Differences in health needs and healthcare ac-cess persist between insured and uninsured

adults in Virginia even when controlling for socio-demographic 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, education, and health status.

Source: Urban Institute, July 2015. Based on the 2013 Behavioral Risk Factor Surveillance System.

Medicaid Expansion Under the ACA

• An estimated 221,000 uninsured Virginians below 100% of FPL would become eligible for public coverage should Virginia expand Medicaid

47.4% of these are between the ages of 19-34

• Overall, 366,000 Virginians who were uninsured in 2013 with incomes below 138% of FPL would become eligible for public coverage should Virginia expand Medicaid

As of March 2015, HHS reported that 127,307 adults in Virginia with incomes between 100 and 138 percent of the FPL were enrolled in the Health Insurance Marketplace.

Documents

The Uninsured in Virginia: An Update Nathaniel Anderson, Laura Skopec, and Genevieve M. Kenney The Urban Institute