Who and Where Are Kentucky's Remaining Uninsured?

Background: While most research has focused on insurance uptake and describing the makeup of the newly insured, less is known about the characteristics among the remaining uninsured in expansion states.

Objectives: Using Kentucky as a case study, we evaluate individual and contextual characteristics to learn more about groups who-despite expanded access to coverage options through US health care reform-reported being uninsured at the end of 2014.

Research Design: Cross-sectional data from Kentucky's Behavioral Risk Factor Surveillance System was linked to county data from the Area Health Resource File, and we used logistic regression models to assess relationships between both person-level and county-level characteristics with uninsured status.

Subjects: The study sample included nonelderly adults aged 18-64 residing in Kentucky during the time of the survey.

Results: Before the implementation of the Medicaid expansion and rollout of the state-based health insurance marketplace, adults who were younger (aged 18-47), unmarried, had lower levels of educational attainment, and considered to be low income were more likely to be uninsured. However, many but not all of these differences faded away by the end of 2014 when only unemployment, low-income status, and Hispanic ethnicity were positively correlated with being uninsured.

Conclusions: At the end of 2014, Kentucky's adult uninsured rate was below 5% and few statistically meaningful coverage gaps remain, suggesting Kentucky's experience under health reform may contribute to long-run closures in disparities in health care access and outcomes.