State Voting Patterns in the 2016 Presidential Election and Uninsured Rates in Non-elderly Adults.

Abstract

Medicaid expansion and the health insurance “Marketplaces” of the Affordable Care Act (ACA) reduced the number of uninsured individuals to record lows in 2016.1 Uninsured rates may have since increased because of recent federal policies, including nullifying the individual mandate and reducing federal funding for Marketplace advertising and navigator programs.2 Even the expressed desires of congress and the President to repeal the ACA may have increased uninsured rates through a phenomenon known as “presidential cueing”3 by decreasing public support for the ACA, particularly in states with a plurality of Republican voters. State-level policies may have enhanced or attenuated the impact of these federal actions on uninsured rates, with specific policies generally varying based on whether states have a plurality of Republican or Democratic voters.2, 4 For example, some states have chosen to not expand Medicaid,2 and some states that initially expanded Medicaid have since applied for “Section 1115” waivers, which would allow for modifications to the Medicaid program such as the implementation of work requirements, that would effectively reduce enrollment.5 The degree to which states have devoted resources to Marketplace outreach and advertisement strategies to compensate for reduced federal funding also varies substantially along party lines.2, 4 Given the varying state responses to federal actions weakening the ACA, we conducted a descriptive study examining recent uninsured rates among adults aged 18–64, stratified by their states’ voting patterns in the 2016 presidential election.