Darkest color indicates lowest uninsured rate; gray represents highest.

DALLAS — Arkansas and Kentucky reported the sharpest reductions in the rate of adult residents lacking health insurance since the federal healthcare law's requirement to have insurance took effect at the beginning of 2014, according to a Feb. 24 Gallup-Healthways report.

Arkansas reduced its uninsured by 11.1 percentage points, cutting the rate nearly in half from 22.5% in 2013.  Kentucky cut its rate by more than half, falling 10.6 percentage points from 20.4% the previous year.  Both states expanded Medicaid eligibility to 138% of the federal poverty threshold.

Oregon, Washington and West Virginia were also among the top five in reducing the uninsured rate. Of the 11 states with the greatest reductions, 10 expanded Medicaid and established a state-based marketplace exchange or state-federal partnership. Montana, which is tied for 10th, is the only exception, according to Gallup.

Nationwide, the uninsured rate dropped 3.5 percentage points last year, from 17.3% to 13.8%, the lowest annualized rate across the seven years of Well-Being Index measurement. No state reported a statistically significant increase in the percentage of uninsured in 2014 compared with 2013.

The data, collected as part of the Gallup-Healthways Well-Being Index, are based on respondents' answers to the question, "Do you have health insurance coverage?"

The state-level data are based on daily surveys conducted from January through December 2014 and include samples sizes that range from 465 randomly selected adult residents in North Dakota to nearly 17,000 in California, according to Gallup.

The uninsured rate in states that have chosen to expand Medicaid and set up their own state exchanges or partnerships in the health insurance marketplace declined significantly more last year than the rate in states that did not take those steps.

Massachusetts has the lowest uninsured rate in the nation for the seventh consecutive year, at 4.6%.

For the seventh consecutive year, Texas has the highest uninsured rate at 24.4%, although that percentage is lower than the 27.0% reported in 2013 and is the lowest rate measured to date for Texas.

Texas has refused to accept federal funding for Medicaid expansion, and current Gov. Greg Abbott has repeatedly sued the federal government in an attempt to stop the expansion of health-care coverage for lower-income groups.

The Affordable Care Act calls for a Medicaid expansion to cover nearly all adults with incomes at or below 138% of the federal poverty level.

Texas could collect $100 billion in federal funds over 10 years if it agreed to expand Medicaid eligibility, but Abbott declared the system “broken.”  The revenue collected in Texas will go to other states.

The Texas Hospital Association estimates that hospitals in the state provide $5.5 billion annually in uncompensated care.

In Utah Gov. Gary Herbert continues negotiations with the Centers for Medicare and Medicaid Services to have a plan with revised, more flexible terms than what is detailed in the Affordable Care Act, currently known as the Healthy Utah plan, the report noted.


Subscribe Now

Independent and authoritative analysis and perspective for the bond buying industry.

14-Day Free Trial

No credit card required. Complete access to articles, breaking news and industry data.