An application for health insurance. (File)
The number of Alabamians without health insurance dropped significantly between 2021 and 2022, according to an American Community Survey analysis from the U.S. Census Bureau.
The percentage of people in the state without insurance fell from 9.9% in 2021 to 8.8% the following year, a 1.1% percentage point decrease. That was nearly double the 0.6% drop in the national rate that year.
The number of people with private insurance also increased in Alabama, by .6%, but not as much as the rate of public coverage, at a 1.1% increase.
Jennifer Tolbert, director of state health reform and an associate director for the program on Medicaid and the uninsured at KFF, said that while a one percentage point decrease in uninsured may seem like a small number, that number represents a big change and puts Alabama closer to the national uninsured average of 8%.
“It’s among the largest drops in the uninsured rate across all states,” said Tolbert.
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The Census Bureau’s analysis found the uninsured rate overall dropped faster in states that have not expanded Medicaid than in those that had. But non-expansion states continue to have higher rates of uninsured people.
In expansion states, the percentage of uninsured people fell from 6.8% to 6.3% between 2021 and 2022. In non-expansion states, the uninsured rate fell 12.8% to 11.8%.
In most non-expansion states, the drop came from an expansion in private coverage, according to the U.S. Census Bureau analysis.
But Alabama and Georgia were the only two non-expansion states that saw growth in public enrollees Despite strict enrollment requirements that effectively limit Alabama Medicaid to children, the elderly and people with disabilities, the program is growing.
Alabama’s Medicaid enrollment increased by about 7.6% percentage points from June 2021 to June 2022, from just under 1.2 million enrollees to nearly 1.3 million. From June 2022 to June 2023, enrollment increased by about 7.5%, from nearly 1.3 million to about 1.38 million. About 26% of Alabama’s population is covered by Medicaid.
Another possibility is Alabamians aging into the Medicare system. Medicare enrolled about 1.07 million Alabamians 65 and older in 2021, according to KFF. Alabama’s median age (39.4 years) is higher than the national average (38.9 years).
But public data will not be available until Oct. 20, and Tolbert said without it, it’s hard to distinguish whether the uninsured rate decreased because of increased Medicare and Medicaid enrollment.
“I would say likely because of the continuous enrollment provision in place in Medicaid throughout 2022 that contributed to the increase in public coverage in Alabama,” Tolbert said, “but again, I will be able to say with far more certainty once we get the public use file in October.”
Alabama’s private insurance coverage is also close to the U.S. average, covering 67% of Alabamians, compared to the 67.2% national average. Alabama’s private insurance insure more people compared to non-expansion states average overall.
Health insurance also became more accessible due to subsidies for insurance plans under the Affordable Care Act. There was an 18% increase in the number of Alabamians who signed up for a plan under the Affordable Care Act (ACA), from 219,314 in 2022 to 258,327 in 2023. But these subsidies are only available for those making between 100% and 400% of the poverty line, leaving those who earn less ineligible. Alabamians who earn between 18% ($4,475) and 100% ($24,860) of the federal poverty rate for a family of three typically fall into this coverage gap.
Sophie Martin, spokesperson for Blue Cross and Blue Shield of Alabama (BCBS of Alabama), the dominant health insurance company in the state, wrote in an email statement that the company is committed to ensuring customers receive the “highest quality medical care at the lowest possible price.”
“Our company is proud that latest reports show Alabama has the fourth lowest average annual single premium and family premium among employers nationwide,” Martin wrote, citing data from the 2022 Medical Expenditure Panel Survey (MEPS) conducted by the Department of Health and Human Services.
Only Oklahoma ($6,713 per year), Mississippi ($6,726 per year) and Utah ($6,746 per year) had lower premiums than Alabama ($6,769 per year) for individual coverage. For family coverage, Oklahoma ($19,003 per year), Kansas ($19,461 per year) and Arkansas ($19,513 per year) had lower premiums than Alabama ($19,575 per year).
For the 2023 plan year, she wrote that price changes for Affordable Care Act individual coverage plans ranged from -2.3% to 0.6%, depending on the plan, with an 0.3% average decrease for ACA Individual Plans. Over 88 percent of the 216,000 members with an ACA Individual plan qualified for an advanced premium tax credit which lowered their 2023 premium.
Tolbert said that Alabama’s private insurance rate of coverage being higher could be for a number of reasons. Workers at the state’s automotive plants are more likely to be insured by private insurance. There is a high military and government presence in Alabama. While insurance through the military would be distinguished from private insurance, coverage through the federal government would be counted private.
“But if there’s a military base, there’s a lot of entities and businesses that support that military base more likely to provide private insurance to their employees. So it’s about the types of businesses and industries that are operating in the state, and whether they are more likely to provide health insurance,” Tolbert said.
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