Tuesday, July 31, 2012

Low-income “Childless Adults” Comprise Large Share of the Uninsured

New DHS Data Confirm Need to Improve Access to Care for Adults without Dependent Children

The latest Family Health Survey results that were recently released by the Department of Health Services (DHS) show that low-income “childless adults” constitute a very large share of uninsured Wisconsin residents.  Lumping together the 2009 and 2010 survey data (to increase the sample size), DHS found that 25% of Wisconsinites who were uninsured for all of the 12 months prior to the survey were low-income adults who aren’t the primary caretaker of a dependent child.

The results are important because most of those so-called childless adults (which is a somewhat misleading term) would gain eligibility if the state uses the option in the Affordable Care Act (ACA) to close the current gap in BadgerCare coverage. The survey found that three-fifths of these uninsured adults had not had a checkup in the past two years, and 27% had been diagnosed with one or more of six chronic conditions.

DHS reports that during the last two years of the state survey there was an average of 81,000 uninsured adults (ages 19-64) who don’t have dependent children and who are in households with income of less than 200% of the federal poverty level (FPL). That represents one-fourth of the estimated 329,000 Wisconsinites of all ages who were uninsured for all of the prior 12 months, and it’s nearly half (46%) of the uninsured Wisconsinites below 200% of FPL.

In reviewing the data, one needs to keep in mind that the combined 2009 and 2010 results don't fully reflect that the state’s BadgerCare Core Plan coverage for childless adults has been falling sharply because of the combination of program attrition and a moratorium on new enrollment. Core Plan enrollment peaked at about 65,000 early in 2010 and has subsequently dropped by about 40,000.

The DHS survey results reveal the following information about the estimated 81,000 uninsured, low-income adults, who I prefer to call non-caretaker adults:
  • 55% were below the federal poverty level, and the other 45% were between 100% and 200% of FPL. 
  • Two-thirds (67%) were non-Hispanic whites, 19% were black, and 8% were Hispanics. 
  • They were about evenly divided between men (49%) and women (51%), and 22% were married. 
  • 66% were living in metropolitan counties. 
The 81,000 figure is considerably below the number of low-income childless adults indicated by the Urban Institute’s analysis of Census Bureau data from the American Community Survey (ACS). Piecing together two Urban Institute reports, it appears that there were about 201,000 uninsured childless adults in Wisconsin in 2010 who could have been covered if the state had been able at that time to use the ACA to fill the current gap in BadgerCare coverage.

I’m not sure why the Urban Institute number is so much larger, especially since they were specifically estimating the eligible adults below 138% of FPL, whereas DHS included adults up to 200% of FPL. However, one part of the explanation is that the Census Bureau’s ACS data is based on insurance status at the time of the survey, rather than being an estimate of who was uninsured for all of the previous 12 months. It’s also possible that the Urban Institute and DHS aren’t defining parents and childless adults in quite the same way, or I might be making an error in interpreting and combining the results of two interrelated Urban Institute reports.

We’ll continue to study the data and try to get a better handle on its implications with respect to the state choice on closing the gap in BadgerCare coverage.  Our blog post on Sunday provides a broader overview of the DHS survey results, including the disparities in insurance coverage.

Jon Peacock

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