Health insurance policy is a critical issue, affecting Americans of all ages and backgrounds. At the same time, who pays for healthcare and how are issues central to the condition of the U.S. economy. People with insurance coverage are more likely to receive timely health services and less likely to incur costly, preventable expenses related to complications of chronic conditions.

In 2017, the healthcare industry accounted for 15 percent of all jobs in Wisconsin, and healthcare spending accounted for $109 billion — 37 percent of Wisconsin’s gross state product in 2014. Therefore changes to health insurance policy at the national level also affect the state’s economy.

The Affordable Care Act, often called Obamacare, was intended to reduce the number of Americans who do not have health insurance coverage. The law was structured to accomplish this goal through several mechanisms, including a major expansion to the federal insurance program available to people living near the poverty line, a policy known as the Medicaid expansion. This element of the ACA was challenged in court, and ultimately its adoption was a state-level decision. Wisconsin did not adopt the Medicaid expansion in the ACA, though the state’s BadgerCare program covers a portion of the population who otherwise would have been eligible to be covered.

Annual U.S. Census data for 2016, released in September 2017, indicate that the ACA resulted in major increases in the number of insured Americans since its implementation. In fact, the number and percentage of people with health insurance has increased in every single state and the District of Columbia.

Since 2013, just prior to the ACA’s implementation, the rate of insurance coverage has increased by 5.9 percent nationally and 3.9 percent in Wisconsin. In 2016, there were an estimated 255,000 more Wisconsin residents with health insurance compared to in 2013. Between 2015 and 2016 alone, Wisconsin’s insured rate jumped up from 94.3 percent to 94.7 percent — a statistically significant increase. This increase marks the third year in a row that insurance coverage rates increased in the state.

Wisconsin’s health insurance rate is among the highest in the U.S. and continues to increase. In 2016, though, the state nonetheless fell in overall rankings. Wisconsin is now in a tie with West Virginia for tenth place for most insured total population. This simultaneous increase in insurance rate but drop in state rankings is happening because other states improved more than Wisconsin. Kentucky bumped past Wisconsin as it continued its meteoric rise in coverage, from 34th in the nation in 2013 to ninth place in 2016. Kentucky’s rapid increase is largely attributable to its adoption of the Medicaid expansion, which benefited its relatively large population of near-poor uninsured adults.

The following map shows the increase in states’ health insurance coverage between 2013-16 as a percentage of the total population of each state. Those states that implemented a full Medicaid expansion are highlighted.

The 31 states and the District of Columbia that adopted the Medicaid expansion have seen bigger increases in health insurance rates since the adoption of the ACA, compared to the 21 states that did not adopt the expansion, including Wisconsin. On average, expansion states increased coverage by 5.8 percent, while the average among non-expansion states was 4.6 percent. The difference between these two groups of states is statistically significant.

The Trump administration campaigned on a platform that included repeal of the ACA, but congressional efforts have so far not achieved this goal. Amid this contested territory and the ongoing uncertain status of federal health policy, the health and economic well-being of Americans in every state remains at stake.