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2020 Election: Healthcare Coverage Landscape Varies in Super Tuesday States

Summary

Ahead of the Super Tuesday primaries on March 3, healthcare remains a top issue among voters. According to January 2020 polling from Bipartisan Policy Center, 56% of individuals ranked healthcare as one of their top 3 issues when determining how to vote in the upcoming election, above the economy (44%), immigration (33%), taxes (31%), gun control (30%), and environmental policy (23%).

Healthcare Market Statistics in Super Tuesday States

As voters in the 14 Super Tuesday primary states consider healthcare proposals from the candidates, Avalere has built on a previous report, analyzing the underlying insurance markets in each state. Given the focus on healthcare, the number of uninsured individuals and populations enrolled in Medicaid and the exchanges could shape voter sentiment at a state level. Key findings in the Super Tuesday states include:

  • Uninsured: Among the Super Tuesday states, MA has the lowest percentage of uninsured residents at 2% and TX has the highest at 18%.
  • Medicaid Enrollment: 12 of the 14 Super Tuesday and early primary states have already expanded Medicaid eligibility under the Affordable Care Act (ACA). As a result, 28% of insured residents in AR and CO are enrolled in Medicaid, while, on the low end, Medicaid represents only 15% of the insured populations in non-expansion states of AL and TX respectively.
  • ACA Exchanges: While the exchange market represents a relatively small source of coverage in Super Tuesday states, ranging from 1% in AR to 7% in UT, premium trends have gained significant media attention since the launch of the ACA. For the first time since the implementation of the exchanges, premiums will decrease nationally, on average, for all plan types in 2020. At the state level, however, average exchange plan premium changes from 2019 to 2020 range from -20% in CO to 12% in NV.
Table 1: Key State-Level Health Insurance Market Detail, 2020 Super Tuesday and Early Primary Elections
State Percent Uninsured Medicaid Expansion Medicaid Enrollment as a Percent of Total Insured Population On-Exchange Enrollment as Percent of Total Insured Population Change in Average Monthly Exchange Market Premium (PY 2019–2020)
Alabama 11% Not Expanded 15% 2% 3%
Arkansas 8% Expanded 28% 1% 2%
California 7% Expanded 28% 3% 1%
Colorado 7% Expanded 22% 3% -20%
Iowa* 4% Expanded 19% 1% -11%
Massachusetts 2% Expanded 20% 5% 5%
Maine 8% Expanded 14% 4% -2%
Minnesota 4% Expanded 20% 2% -1%
North Carolina 11% Not Expanded 18% 3% -6%
New Hampshire* 7% Expanded 12% 3% -1%
Nevada* 11% Expanded 19% 2% 2%
Oklahoma 11% Not Expanded 18% 3% 3%
South Carolina* 10% Not Expanded 17% 3% -4%
Tennessee 10% Not Expanded 19% 2% -1%
Texas 18% Not Expanded 15% 2% -1%
Utah 8% Expanded 9% 7% -2%
Virginia 7% Expanded 15% 2% -4%
Vermont 3% Expanded 23% 4% 12%

*Early primary election or caucus has concluded

PY: Plan Year

Methodology

To conduct the analysis, Avalere utilized the estimated sources of health insurance coverage in the United States in 2020 from the proprietary Avalere All-Payer Enrollment Model. To determine the latest Medicaid enrollment in early presidential primary and Super Tuesday states, Avalere used CMS’s Preliminary October 2019 Applications, Eligibility, and Enrollment Data (last updated January 10, 2020). Avalere utilized the recently released 2020 Individual Market HHS Landscape Files of exchange plan premiums in 3 Healthcare.gov states and used the 2020 Federal Health Insurance Exchange Enrollment Period Final Weekly Enrollment Snapshot to determine exchange market enrollment in state with federally facilitated exchanges. To determine state-based exchange market enrollment and average premiums, Avalere used state-based exchange announced enrollment figures for plan year 2020 and state health insurance rates reports. Polling data was pulled from the Bipartisan Policy Center and Morning Consult 2020 Healthcare Priorities Presentation.

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