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What regions in Colorado will benefit most from ACA coverage expansions?

Earlier this morning, the Kaiser Family Foundation released a fascinating map that examined the effects of the health insurance coverage expansions contained within the Affordable Care Act (ACA). This analysis focused on those individuals who are likely to be eligible for Medicaid or federal tax credits to subsidize the cost of insurance, i.e. those with incomes up to 400% of the federal poverty level (FPL) who are currently uninsured or who have purchased health insurance directly from a carrier (the individual market).

In this map, the darker colors represent areas that have a high percentage of people either uninsured or in the individual market. Kaiser predicts that these are the areas that will benefit the most from the ACA coverage expansions. The analysis is based on data from the U.S. Census Bureau’s American Community Survey (ACS).

According to this analysis, Colorado’s Western Slope stands to see the biggest change under health reform, meaning it will most likely have the highest increase in the percent of people with health insurance.

Percentage of the Nonelderly Population With Income Up to Four Times the Poverty level Who Were Uninsured or Purchasing Individual Coverage, 2010

Percentage of the Nonelderly Population With Income Up to Four Times the Poverty level Who Were Uninsured or Purchasing Individual Coverage, 2010

Source: Kaiser Family Foundation Analysis of the American Community Survey, 2010. For more information on the methodology behind this analysis, click here.

In Colorado, we’re fortunate to have another data source to answer questions about health insurance status: the Colorado Health Access Survey, or CHAS, which is a program of The Colorado Trust. It’s important to note that the ACS differs from the CHAS in many ways, and thus we couldn’t perfectly replicate the Kaiser analysis. For example, while Kaiser estimated undocumented Americans and removed them from the study, we didn't do that with the CHAS. (For those of you interested in the methodological differences between the surveys, check out my colleague Jeff Bontrager’s blog post.)

That said, this map using CHAS data displays a very similar trend to what we saw in the Kaiser analysis:

Percentage of the Nonelderly Coloradans With Income Up to Four Times the Poverty Level Who Were Uninsured or Purchasing Individual Coverage, 2011

Percentage of the Nonelderly Coloradans With Income Up to Four Times the Poverty level Who Were Uninsured or Purchasing Individual Coverage, 2011

Both the ACS and the CHAS suggest that Coloradans who live on the Western Slope are likely to benefit the most from health reform’s coverage expansions. This is partially because this region, with some exceptions, has the highest uninsured rates in the state, and a major goal of the Affordable Care Act is to get uninsured individuals covered. In addition, Coloradans in these rural communities are more likely to be self-employed or have insurance through the individual market—two groups that may benefit greatly from the larger purchasing power of the Colorado Health Benefit Exchange.

Anticipating how the health care world will shift in the next few years is tricky, and unfortunately my crystal ball isn’t much better than yours. However, surveys like the ACS and CHAS are tools we can use to make an educated guess about what will happen in 2014 and beyond.