The South is Now Home to Half of the Nation's Uninsured

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In the self-fulfilling prophecy of the decade, the states that resisted the Affordable Care Act the most are the ones who benefited the least.

Close to 12 million people have gained health insurance coverage because of the Affordable Care Act. But the millions who have yet to secure health insurance are disproportionately concentrated in the South more than ever before, according to a new analysis from the Urban Institute. Considering that the South was already home to over 4 in 10 of the nation’s uninsured, that’s saying quite a lot.

Southerners made up 41.5 percent of the uninsured as of September 2013. But now that millions of people around the country – and mostly in other parts of the country – have gained health insurance because of the Affordable Care Act, Southerners now make up 48.9 percent of the nation’s uninsured. Meanwhile, the Northeast, Midwest and the West have all seen declines in their share of the uninsured.

As a result of these shifts, almost half of all uninsured Americans now live in the South.

So what changed in the South between last fall and this summer? The issue is more about what didn’t change. While people in every state gained access to federal health care exchanges, much of the rest of the country expanded Medicaid – while the South did not.

The states that expanded Medicaid had roughly the same uninsured rate on average as the states that chose not to, as of September 2013. Now, there is a more than 20 percentage point gap between the two.

The disproportionate concentrate of the uninsured in the South is due in large part to Texas, where 1 million more people could have been insured had the state expanded Medicaid. As it is, the group that should have been eligible for Medicaid is now eligible for neither Medicaid nor subsidies for the federal marketplace.

The large majority of the uninsured remain that way because of financial concerns – an issue that the Medicaid expansion was supposed to address. ¬†According to the Urban Institute, three out of five remain uninsured because of high insurance costs or other affordability issues – not a personal choice or a lack of interest. Without a Medicaid expansion or access to subsidies for the health insurance marketplace, it’s highly unlikely that the factors keeping the uninsured from getting health insurance will change.

According to the Urban Institute,

    “The prospects for gaining coverage are much less promising for the two out of five of the nation’s uninsured who have family incomes at or below 138 percent of FPL but live in states that have not chosen the Medicaid option. Most are likely to remain uninsured, given the lack of subsidized coverage options for them. While some may qualify for Medicaid or subsidized coverage through the Marketplaces, most low-income adults in states that have not opted to expand Medicaid fall into the “coverage gap” between very low Medicaid income eligibility levels and minimum income levels for Marketplace subsidies. For these adults, cost remains an often insuperable barrier to coverage.”

Texas has the option of insuring 1 million people who can’t currently afford health insurance by expanding Medicaid. The cost would fall almost entirely on the federal government. But Rick Perry and his allies have decided that these people’s health care is the price that the state will pay to continue to make a statement about Obamacare.


About Author

Emily Cadik

Emily is a Texas ex-pat and proud Longhorn living in Washington, DC, where she remains connected to the Lone Star State through her work on BOR and her enthusiasm for breakfast tacos. She works on affordable housing policy, and writes about health care, poverty and other social justice issues.

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