A major goal of the Affordable Care Act was to reduce the number of Americans who are uninsured. The main provisions of the law intended to help achieve that reduction include the individual mandate, expansion of Medicaid, creation of the health insurance marketplaces and introduction of subsidies for individuals purchasing coverage, extension of coverage to adult children up to age 26, and requirements that certain employers offer affordable health insurance coverage or pay a penalty. Requirements that insurers cover those with preexisting conditions and prohibitions on rescission of coverage were also intended to further expand the number of Americans with access to affordable coverage. Because of these policies, estimates show that 16 million Americans gained insurance between 2010 and 2015.1 Nevertheless, an estimated 29 million Americans remained uninsured in 2015.2
This brief examines the characteristics of those in Michigan who reported being uninsured approximately two years after the ACA’s major coverage provisions went into effect beginning in 2014. The brief is based on data from the Center for Healthcare Research & Transformation’s 2015 Cover Michigan Survey of Michigan adults, fielded between October and December 2015. Comparison data is drawn from the 2009, 2011, 2012, and 2014 Cover Michigan Surveys.
Since 2009, Michigan’s uninsured rate has declined dramatically. Specifically:
- Five percent of respondents reported being uninsured at the time of the survey. By comparison, in 2012, 14 percent of respondents reported being uninsured.
- More than twice as many respondents reported having been uninsured at some point during the year before the survey than were uninsured at the time of the survey, indicating that many of the uninsured gained or regained coverage relatively quickly.
- Forty-one percent of the uninsured reported annual household incomes below $30,000, and 54 percent reported incomes between $30,000 and $59,999.3
- Half of uninsured respondents worked full time.
- Sixty-four percent of the uninsured were male.
- Thirty-nine percent of uninsured respondents were between the ages of 18 and 30.
- Half of uninsured respondents lived in small cities or towns.
Overall, those who remain uninsured are not a static group, and most Michiganders who reported having been uninsured during the year prior to the survey were uninsured for only short periods.
Fewer Michiganders reported being uninsured in 2015 than in any year since this survey was first fielded in 2009. Only 5 percent of Michiganders4 reported that they did not have insurance at the time of the 2015 survey, compared to 14 percent in 2012 and 7 percent in 2014. Figure 15
Although the number of Michiganders without insurance has declined significantly, achieving continuous coverage may still pose a challenge. Respondents were significantly more likely to report having been uninsured at some point during the year prior to the survey than they were to report being uninsured at the time of the survey. Thirteen percent of respondents reported that they were uninsured for at least part of the year leading up to the survey, compared to only 5 percent at the time of the survey.
Of those respondents who were insured at the time of the survey but who had lacked continuous coverage during the 12 months prior to the survey, two-thirds had been uninsured for 3 months or less and only 5 percent had been uninsured for 10 months or more. Figure 2
Forty-one percent of uninsured respondents reported annual household incomes below $30,000, and 54 percent reported incomes of $30,000-$59,999. Only 5 percent of uninsured respondents reported incomes over $60,000. Figure 3
Thirty-six percent of the uninsured reported that they had a high school education or less, 33 percent reported that they had taken college courses but did not graduate, and 31 percent reported that they were college graduates. Half of uninsured respondents reported that they worked full time, 19 percent reported that they worked part time, and only 9 percent reported that they were unemployed. Figure 4
Sixty-four percent of uninsured respondents were male and 36 percent were female. Thirty-nine percent of uninsured respondents were between the ages of 18 and 30, 36 percent were between the ages of 30 and 49, 20 percent were between 50 and 64, and 5 percent were 65 or older. Figure 5
Eighty percent of the uninsured were white and 20 percent were African American. No uninsured respondents reported being of Hispanic origin. Fifteen percent of those who reported being uninsured lived in rural areas, 50 percent lived in small cities or towns, 14 percent lived in suburban areas, and 20 percent lived in urban areas. Characteristics of the uninsured did not differ significantly between 2014 and 2015.
The survey data presented in this brief were produced from a series of survey questions added to the Michigan State University Institute for Public Policy and Social Research (IPPSR) quarterly State of the State Survey. The survey was fielded between October and December 2015, and included a sample of 972 Michigan adults, with a 17.0 percent response rate. The margin of error for the entire sample was ±3.9 percent. The sampling design, a random stratified sample based on regions within the state, was a telephone survey conducted via landline and cellular phones of Michigan residents.
For analytical purposes, survey data were weighted to adjust for the unequal probabilities of selection for each stratum of the survey sample (for example, region of the state, listed vs. unlisted telephones). Additionally, data were weighted to adjust for non-response based on age, gender, and race according to population distributions from 2009-2013 American Community Survey data. Before weighting, 40 respondents reported being uninsured. Respondents who reported both Medicare and Medicaid coverage were considered Medicaid recipients for the purpose of this analysis. Results were analyzed using SAS 9.4 software. Statistical significance of bivariate relationships was tested using z tests or chi-square tests for independence. All comparison tables are statistically significant at the p ≤ 0.05 level unless otherwise noted. A full report of the IPPSR State of the State Survey methodology can be found at: http://ippsr.msu.edu/soss/.