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11.5 percent of Ohioans go without health insurance

Increase in government-backed plans such as Medicaid

Ohio has a lower share of people without some form of health insurance than most other states and the nation, newly released Census data show.

Ohio’s overall uninsured rate was 11.5 percent for 2012, according to the U.S. Census Bureau’s 2012 American Community Survey released this week. The state’s rate was in a statistical tie with South Dakota for 32nd-lowest in the nation, and lower than the 14.8 percent national uninsured rate.

Ohio also ranked fairly well among the states in percent of uninsured children. Ohio’s rate of 5.3 percent of uninsured children was below the 7.2 percent national rate, and in the bottom half of states. In addition, uninsured rates for all of Ohio’s 13 larger metropolitan statistical areas were in the bottom half of the 366 large metros across the country.

But the news in the numbers may not be all positive.

Part of the story has been an increasing share of people under 65 on public health insurance, combined with a decreasing percentage of people covered by private health insurance, which includes employment-based coverage.

Public health insurance is defined by the Census Bureau as including the federal programs Medicare, Medicaid and other medical assistance programs; VA Health Care; the Children’s Health Insurance Program, or CHIP; and individual state health plans.

Private health insurance still covers close to two-thirds of Ohioans under age 65, but the percentage in shrinking.

The fraction of people in Ohio under 65 with private health insurance dropped 5 percentage points — to 65.2 percent between 2008 and 2012. Meanwhile, the percentage of people on public coverage increased almost 5 percentage points, from 16.7 percent to 21.4 percent.

That left 13.3 percent of Ohioans under 65 uninsured in 2012. (Almost 98 percent of adults 65 and over in Ohio are covered by federal Medicare.)

“When the economy is growing, we tend to see higher levels of employer-sponsored coverage, and higher levels of coverage overall,” said Genevieve Kenney, of the Washington-based Urban Institute.

“But the flip side is when the economy isn’t doing so well, especially for children, we do see greater reliance on Medicaid and CHIP across the country. We’ve seen that during recessionary time periods.”

Kenney was coauthor of a report released Wednesday that found children’s enrollment in the federal CHIP program has been increasing nationwide. The report attributes that increase in part to state and federal efforts to raise awareness of CHIP and to get eligible kids enrolled.

Overall, she said, increases in children’s coverage over the last 15 years has not been coming from the private side.

“It’s really been more of the public sector (government) filling in where the private sector gaps are,” Kenney said.

In fact, state data show total Medicaid enrollment has increased by more than one third (600,221 people) since fiscal year 2008.

One main driver of that increase from 2008 to 2010 was the Great Recession, said Sam Rossi, a spokesman for the Ohio Department of Medicaid.

“In 2008, the country witnessed the recession and that applied to Ohio as well in the two years after it,” Rossi said. “People needed help.”

But in the last few years, as the economy has been slowly recovering, Medicaid enrollment has continued to expand. In the past state fiscal year (which ended July 1), Medicaid enrollment increased by almost 166,000 or 7.5 percent.

That might be because the state’s recovery hasn’t been all that strong. The new Census data show a mixed economic picture for Ohio at best.

While the unemployment rate for civilians has decreased from 7.3 percent in 2010 to 5.7 percent in 2012, so has the percentage of the 16-and-over population participating in the labor force.

Ohio’s median household income, meanwhile, has shrunk by about 7.8 percent from 2008, while the poverty rate has increased from 13.4 percent in 2008 to 16.3 percent in 2012.

Mary Wachtel, of the nonprofit Health Policy Institute of Ohio, saw two forces driving the increase.

First, she said, since the basic eligibility levels for Medicaid in Ohio haven’t changed since 2000, much of the increase is from families falling into lower income brackets – a trend indicated by the state’s declining median household income.

Children are eligible if their family’s income falls below 200 percent of the federal poverty level. Adults with children are eligible at 90 percent of the poverty level.

“I think that the numbers really are a reflection of what’s going on in the economy,” Wachtel said. “So more kids have become enrolled, probably because more kids are falling into that income level.”

But, Wachtel said, the continued increase in the last two years could be the result of more people hearing about Medicaid because of the debates about the Affordable Care Act and whether Ohio should expand Medicaid coverage.

“The issue of health insurance is just much more prominent and visible than it had been in the past, which is causing people to check out their options,” Wachtel said.

Ohio still has far more uninsured that many other states – particularly Massachusetts.

Massachusetts had, by far, the lowest rate among the states, with 3.9 percent of the population without health insurance.

Since 2006, Massachusetts has had a state law that — like the federal Affordable Care Act — requires almost all residents to buy a minimum level of health insurance. The state provides free coverage to residents earning less than 150 percent of the federal poverty level.

That law, signed by then-Gov. Mitt Romney, was the blueprint for the federal Affordable Care Act.

Compared to Massachusetts, Ohio had a rate three times as high; the nation had a rate almost four times as high; and Texas and Nevada, with 22.5 percent uninsured, had close to six times the rate of uninsured population.

The uninsured rate of Massachusetts dropped by almost half in the year following its implementation, according to a report by the Kaiser Family Foundation.

Could Ohio and the rest of the nation see similar declines in coming years? Wachtel said it depends on policy decisions still to be made.

While the non-partisan institute doesn’t take positions on policy, it did undertake a study with The Ohio State University and the Urban Institute to see what the effects would be of a debated expansion of Medicaid in Ohio, which has been backed by Gov. John Kasich but rejected by the Ohio Legislature.

If Ohio does expand Medicaid – as is called for in the Affordable Care Act, but is up to the states to decide – the state would still have about 636,000 uninsured Ohioans in the year 2022, Wachtel said.

But if Ohio doesn’t expand Medicaid, more than 1 million residents wouldn’t be covered.

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