Census data is out – New York continues to lead in insuring consumers

The new 2018 census data numbers are out this this morning. 

The bad news is that uninsurance numbers increased across the country by 1.9 million in 2018, despite the positive economy. This was the first increase in uninsured since the Affordable Care Act was fully implemented in 2014. Here’s a New York Times article with more details.

BUT, there’s great news in New York, which was one of just three states in the country to have a decline in our uninsurance numbers, from 1,113,000 in 2017 to 1,041,000 in 2018 (our uninsurance rate declined from 5.7% to 5.4%). 

New York’s continued decline in uninsured residents is inextricably linked to its adoption of the high quality, affordable, Essential Plan, which saw an increase in enrollment from 665,000 in 2017 to 739,000 in 2018.  Other important factors include:

  • One-stop shopping: you can apply for the full spectrum of coverage, including Medicaid, Emergency Medicaid, Child Health Plus, the Essential Plan, Qualified Health Plans and tax credits, all through the same NY State of Health application
  • Robust Navigator funding of $27 million a year

Congratulations New Yorkers! And let’s keep up the good work!

The CDC released early results from its National Health Interview Survey and it echos some of the data we’ve already seen. In most states, fewer people have health insurance – but in New York, more people do! There wasn’t enough data to know whether or not the change was meaningful, but it matches what we know from other sources. And even holding steady is an achievement in an era where the Trump Administration is doing everything it can to sabotage health insurance programs.

This chart, from the CDC’s report, shows a small increase in the number of insured people – while it could be that we just stayed the same, we can be proud of that too given how many people in other states lost coverage.

For example, the NY State of Health released final numbers recently the last open enrollment. Over 4.7 million New Yorkers used the Marketplace to buy health insurance or enroll in public plans, the most ever! The increases happened in every single county of the State.

We’ve always argued that robust investment in our Marketplace and consumer-assistance programs pays off, but comparing outcomes here to those in other States shows just how important those investments are. Some States chose to use the federal Marketplace infrastructure when implementing the Affordable Care Act. New York chose to build its own, a harder task, but with the result that our Marketplace integrates all of our programs perfectly.

We didn’t foresee an Administration that would work so hard to hurt those Marketplaces, but the decision to create our own infrastructure has protected us from it. In those other States, funding for marketing and for consumer assistance programs is controlled by the federal government. Even the amount of time people have to enroll is controlled by the federal government. So now that we have an Administration that wants those Marketplaces to fail, they’ve cut funding for marketing and consumer assistance and drastically shortened the amount of time people have to enroll. New York has done just the opposite, and achieved the opposite result.

As we talked about last week, we still have a lot to do to get to universal coverage. People without health insurance in New York are disproportionately part of racial and ethnic minority communities. But as a state we have options, and now we have proof that State-level strategies can make a big difference.

On Tuesday we released an agenda for achieving racial justice in health care in New York. Today we’ll take a closer look at one factor that contributes to inequities in health care – white New Yorkers are more likely to have health insurance than others.

The most recent data on health coverage in the United States comes from the Census Bureau’s Small Area Health Insurance Estimates (SAHIE) for 2017. Right off the bat there are a couple missing pieces. The only racial and ethnic categories available for analysis are White alone, Black alone, and Hispanic (of any race). For one, what about people of Asian descent or who are mixed race? And second, people who say their ethnicity is Hispanic may have very different health care experiences depending on their race. We can’t pick up on something like that using this data-set.

We also can’t look at race and ethnicity at the county level, something that the SAHIE does provide for some other categories. It is especially challenging to get data by race and ethnicity at local government levels because in many counties of New York, the populations are too small to allow enough data points to meaningfully analyze trends.

Examining the available data shows some interesting differences in health insurance coverage depending on race and ethnicity. At every income category, people who said they were Hispanic are much more likely to be uninsured. Overall, about 9 percent of Hispanic people were uninsured, compared to 5.7 percent of people who reported their race as Black and only 3.5 percent of people who reported being White.

Looking at the data by income reveals some interesting differences:

Below 138% of the Federal Poverty Level:

People who reported their race as Black alone and White alone have almost the same likelihood of being uninsured (7.4 percent and 7.8 percent respectively). But for Hispanic (any race), the percent of uninsured at this level is shocking: 14.5 percent.

At this income, most New Yorkers are eligible for Medicaid. Some immigrants are eligible for the Essential Plan, which was created through the Affordable Care Act (ACA). The ACA excludes fewer immigrants from coverage than the Medicaid statute. That means New York was able to use the Essential Plan to cover many immigrants who would be income-eligible for Medicaid otherwise. But there are still many immigrants with very low-incomes who are not allowed to participate in public health programs because of their immigration status.

Between 138 and 400% of the Federal Poverty Level:

At this level there is more of a gap between the Black alone and the White alone categories: 8.2 percent of people who said their race was Black alone were uninsured, compared to 6.3 percent of people who said their race was White alone. People who said they are Hispanic were still uninsured at shockingly high rates: 14.5 percent.

At this income level, people move from eligibility for public coverage through Medicaid to public coverage for the Essential Plan and then into the private market. Essential Plan eligibility goes up to 200 percent of the federal poverty level. Above that, most uninsured New Yorkers can use the New York State of Health to purchase insurance and will be eligible for some level of premium subsidy. There are some glaring exceptions: depending on their type of immigration status, many immigrants are not allowed to purchase insurance on the New York State of Health, even if they use their own money and chose not to receive any assistance.

Above 400% of the Federal Poverty Level:

At this income level the gaps between Black alone and Hispanic (any race) close a bit, but the gaps between those categories and White alone increase. Only 2.2 percent of people who reported being White alone said they were uninsured. For Black alone 5 percent were uninsured and for Hispanic (any race) 6.5 percent were uninsured.

At this income New Yorkers are no longer eligible for any type of public coverage or premium assistance. Native-born New Yorkers and some immigrants can use the New York State of Health to shop for insurance and pay the full premium themselves.

On Friday, June 22, more than 70 HCFANY members from across the state gathered in Albany for our annual spring to learn about the Coalition’s ongoing and upcoming work to strengthen and expand health coverage all for New Yorkers and promote health equity. As you all know, it has been a very challenging year for health care, and we are very grateful to all who attended and engaged with us!

The agenda included an Advocates’ Panel during which we heard updates on HCFANY work on New York’s indigent care pool and safety net hospitals and the Coverage 4 All Campaign for immigrant coverage. We also discussed strategies for improving market stabilization and affordability in the individual market. Slides from the presentation are available here.

We were also honored to present our annual “Consumer Health Champion” Award to the grassroots groups, the “New York Grassroots Defenders of Health Care” who have been so instrumental in the fight to defend the ACA and Medicaid here in New York. Awardees included: ACR Health, “Faso Friday,” Long Island Save Our Health Care Alliance, NY-11 for Health Care, Rochester ADAPT, and Saratoga Progressive Action.

The meeting concluded with discussion and planning groups on federal advocacy, protecting New York State’s individual market, and preserving and expanding immigrant coverage.