A year and half after the Affordable Care Act went into effect, the percentage of Americans who lack any form of health insurance continues to decline, according to a Gallup poll released Monday. The poll found that the uninsured rate in the U.S. fell from 17.3% in 2013 to 11.7% in the first half of 2015.
But the survey results also show that reductions in the ranks of the uninsured have been greatest in the states that fully enacted the law's recommendations. The 22 states that chose to expand Medicaid and set up their own state exchanges or partnerships in the health insurance marketplace saw their uninsured rates decline by a collective 7.1 percentage points since the end of 2013, according to the poll. The 28 states that failed to implement one or both of those measures saw only a 5.3 point collective decline.
Many of the states hostile to the Affordable Care Act already had uninsured rates above the national average prior to the law’s passage, and as rates have declined more rapidly in states that opted for full implementation, stark disparities have opened up between individual states. Only 2.7% of Rhode Island residents were uninsured in the first half of 2015; in Texas, that figure was 20.8%, according to Gallup.
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Gallup found that the steepest declines in uninsured rates came in two politically conservative states that fully embraced the law -- Arkansas and Kentucky have seen their uninsured rates drop by 13.4 and 11.4 percentage points, respectively.
As America's uninsured rate has declined, the Affordable Care Act's popularity has been inching steadily higher. Shortly after the Supreme Court upheld the law in July, Gallup found 47% of Americans approving of the law -- its highest approval rating since 2012.
If evidence of the law’s efficacy and popularity continues to accrue, it may help nudge a few more states into full implementation. Alaska Gov. Bill Walker recently announced he would pursue Medicaid expansion over the objection of his state's legislature, and deep red Utah has also moved toward a modified form of Medicaid expansion in recent months.