Deteriorating Health Insurance Coverage from 2000 to 2010

Coverage Takes the Biggest Hit in the South and Midwest

A report funded by the Robert Wood Johnson Foundation, as part of its Affordable Care Act (ACA) Implementation—Monitoring and Tracking Series, examines insurance coverage rates by region of the country, and finds that coverage in the South and the Midwest experienced the biggest declines.

Prepared by researchers at the Urban Institute, the report compares insurance coverage trends for children, parents, and adults without dependent children by income within each of four regions over the last decade, and finds that:

  • The South and the West had lower employer-sponsored insurance (ESI) and overall coverage rates than the Midwest and Northeast;
  • The South and Midwest experienced the largest declines in ESI and insurance rates for adults;
  • Parents in the South experienced the smallest increase in Medicaid and, as a consequence, experienced larger increases in uninsurance than parents in other regions; and
  • Children in the South and West experienced increased insurance rates due to gains in Medicaid/Children’s Health Insurance Program coverage.

The authors note that as regions and states start to fully implement the ACA, the legislation will likely have differing coverage effects geographically. They conclude that states in regions with large low-income populations and high uninsurance rates—most notably the South and West—are likely to experience larger enrollment gains through the new Medicaid expansion, if those states choose to expand their programs.

This report is one in a series of briefs examining coverage trends among different groups targeted by ACA coverage expansions.