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Illinois sees greater decrease in uninsured population than rest of nation, most surrounding states in first year of ACA implementation

Compared to the rest of the nation and most surrounding states, Illinois saw a larger decrease in the number of citizens without health insurance in the first year of implementation of the Affordable Care Act (ACA).

According to a policy brief (download here, PDF) published today by the University of Illinois Institute of Government and Public Affairs, the proportion of non-elderly (i.e., 64 or younger) Illinoisans without health insurance decreased by 2.6 percentage points, from 15.7 percent to 13.1 percent. This is a larger decrease than in the rest of the U.S. (2.1 percent), Indiana (1.2 percent), and Iowa (0.08 percent). In Michigan and Wisconsin, uninsured numbers increased (each by 0.1 percent). Only two neighboring states fared better than Illinois: Missouri (3.3 percent) and Kentucky (5.6 percent).

“Two factors likely contributed to Illinois’ numbers: Medicaid expansion and the Health Insurance Marketplaces,” said health economist Robert Kaestner, who authored the policy brief using new data from the U.S. Census Bureau.

Illinois expanded Medicaid, whereas Indiana and Wisconsin did not. Michigan expanded but imposed co-pays and premiums. Missouri did not expand Medicaid, but saw a substantial rise in Medicaid enrollment, likely due to increased unemployment between 2013 and 2014. “Although Medicaid expansion comes at a cost for Illinois, it was effective in getting people insured,” Kaestner said.

Kentucky experienced the second largest decrease in uninsured population in the nation despite job growth well below average, which can likely be attributed to its widely praised state-run health insurance marketplace. Like Kentucky, Illinois experienced slower job growth than the rest of the nation and greater growth in private health insurance coverage. “The Health Insurance Marketplaces played an important and effective role in Illinois by allowing people to obtain private insurance through avenues beyond their employer,” Kaestner said.

The decrease in the uninsured was particularly large for low-educated Illinoisans. Among those aged 18 to 64 with a high school education or less, the uninsured rate decreased by 5.7 percentage points between 2013 and 2014. This decrease was substantially larger than the 3.7 percentage point decrease observed for the country as a whole and larger than all surrounding states except Kentucky.

Similarly, among younger adults (i.e., ages 18 to 35) in Illinois, the decrease in uninsured was particularly large—4.8 percentage points—compared to the 3.7 percentage point decline for this group in the rest of the U.S. and most surrounding states.