At Doorstep to ACA Implementation, Iowa Sees Decade Drop in Coverage

Census: 1 in 9 Lack Health Insurance in 2011-12

PDF of this release, 2 pages

Explanation of CPS vs ACSIOWA CITY, Iowa — As the nation prepares for the 2014 implementation of the Affordable Care Act, a steep recession and compensation trends have left 1 in 9 working-age Iowans and children without insurance.

According to the Census’ Current Population Survey (CPS) data released Tuesday, on average in 2011 and 2012, 11.6 percent of Iowans under 65 were uninsured throughout the year.

That represents a 2.4 percentage-point increase from 1999-2000.

“Iowans are less likely to receive health insurance through their jobs, a trend we have seen for some time, while private insurance has become increasingly costly,” said Peter Fisher, research director for the Iowa Policy Project, part of the Iowa Fiscal Partnership. 

“Public health insurance programs have stepped in to help. With hawk-i and Medicaid, Iowa has managed to prevent the number of uninsured children from rising over the past 12 years. This is despite a large drop in the number of children covered by their parents’ employment-based policies.”

The data show that over 12 years, the number of Iowa children covered by employer-sponsored insurance has dropped by 114,000.

Specific estimates for Iowa from the new CPS data on health insurance, using two-year averages of information (see box at right):

  • For Iowans under age 65, 11.6 percent were uninsured, on average, in 2011-12 — up from 9.2 percent in 1999-2000. That represents 301,450 people, up from 224,993 in 1999-2000.
  • For Iowa kids under 18, there was not a marked change in insurance access over the decade, with the uninsured population at 5.1 percent in 2011-12, compared with 6 percent in 1999-2000. The improvement was not considered statistically significant.
  • Medicaid coverage for kids under 18 stood at 33.1 percent in 2011-12 — 1 in 3 Iowa children, or 240,852 individuals — up from 13.7 percent in 1999-2000.
  • Medicaid coverage for all Iowans under 65 stood at 17.1 percent in 2011-12, more than twice as high as the 7.4 percent estimate for 1999-2000.
  • Employment-based coverage for Iowans under 65 fell by nearly 12 percentage points over the 12-year period, going from 76.3 percent in 1999-2000 to 64.5 percent in 2011-12. Census estimates nearly 187,000 fewer Iowans had coverage through an employer-based plan in that period.

“As we have seen in past Census estimates, public health insurance programs — including hawk-i for kids, Medicaid and Medicare — have made a big difference in assuring access to health care when their jobs or the individual marketplace made it difficult for individuals. We need these programs,” Fisher said.

“We also have seen these trends on employment-based insurance before. While those trends are not exclusive to Iowa, it is a reflection of what we’ve seen in our State of Working Iowa reports, as health benefits have sagged over the past decade.”

Census will release another set of information on Thursday, from a separate, larger survey that is considered a better measure of state-level and local-level data.

Two major provisions of the Affordable Care Act will dramatically reduce the number of uninsured Iowans starting in 2014. First, more will gain health coverage through Iowa’s acceptance of federal funds to expand Medicaid.

Single adults making up to 138 percent of the poverty line will be covered at an affordable cost under Iowa’s Medicaid Expansion, noted Charles Bruner, executive director of the Child & Family Policy Center.

In addition, Iowans who cannot get affordable insurance through their jobs, but earn too much to qualify for Medicaid, will be able to sign up for coverage for 2014 through the state’s new health insurance marketplace.

Iowa Fiscal Partnership analysts cautioned that the state-level information coming Thursday from the larger ACS can be expected to provide a better look at recent changes in health coverage in Iowa. But because ACS is a more recently developed survey and did not measure health coverage until 2008, CPS provides a better look at longer-term trends.

IFP is a joint public policy analysis initiative of two nonpartisan, nonprofit Iowa-based organizations, the Iowa Policy Project in Iowa City and the Child & Family Policy Center in Des Moines. Reports are at

#     #     #     #     #

Note: A simple comparison of the Current Population Survey and the American Community Survey is available at