Wichita — Federal pandemic programs that buoyed health insurance rates nationwide in 2021 didn’t ultimately lead to an increase in coverage in Kansas — meaning that, for the first time in decades, Kansans are significantly less likely to have health insurance than the U.S. population as a whole.

As millions of Americans lost jobs and with it their employer-based health insurance, the federal government enacted broad relief measures to help people access coverage. Those programs contributed to a marked drop in the rate of uninsured Americans in 2021 to match a prior record low of 8.6%, according to new data released this past week by the Census Bureau.

But the rate of uninsured Kansans remained steady between 2019 and 2021 at 9.2%. And uninsured rates for people of color in Kansas remain even more elevated: 14.1% of Black Kansans lack health insurance compared to 9.6% in the U.S. overall. Of the Kansas Hispanic population, 20.3% are uninsured, compared to 17.7% in the U.S. overall.

One reason insurance rates are lower in Kansas is the state’s failure to expand Medicaid eligibility under the Affordable Care Act. As of 2021, 36 states and the District of Columbia had expanded Medicaid. Gains in insurance coverage were higher on average in those places.

The new data suggests that the pandemic programs did help many Kansans obtain or keep health insurance coverage, even if they didn’t ultimately cause the overall insurance rate to increase.

Public health insurance coverage in the state swelled 1.5%, at a similar rate to the U.S. as a whole, likely thanks to a provision that prevented states from kicking most people off of Medicaid during the pandemic.

“The Medicaid continuous coverage provision drove increases in Medicaid that very likely prevented an increase in the uninsured rate in Kansas,” said Gideon Lukens, director of research and data analysis for health policy at the Center on Budget and Policy Priorities.

But those gains were offset by a considerable decline in private health insurance coverage. Kansas saw a 1.7% drop in private coverage, more than four times the national rate of decline.

That drop can be largely tied to a decline in employment-based health coverage. There was a small, but not statistically significant, increase in the percentage of Kansans who purchased health insurance directly, including from the state’s health care marketplace. The American Rescue Plan Act made that insurance cheaper for low- and moderate-income people.

Phillip Steiner, a senior analyst at the Kansas Health Institute, said there are a few reasons why people could have lost employment-based coverage.

“It could be people changing jobs, or opting for jobs without coverage, or people leaving the labor force,” he said. “But it could be people also opting out of their employer-sponsored plans that they have available to them. We’ve seen premiums climbing pretty steadily in Kansas.”

The institute receives funding from the Kansas Health Foundation, a funder of the Kansas News Service.

The Census Bureau said a nationwide drop in employment-based health insurance partially stems from a rise in people working in jobs that are less likely to offer health insurance, like food service and construction. The bureau will release state-level data on the issue next month, but a similar story could be playing out in Kansas.

Once the federally declared public health emergency and the Medicaid continuous coverage provision end — which could happen as soon as October — the federal government estimates 15 million Americans will lose their health insurance, including approximately 5 million children.

Some will have access to Marketplace subsidies and other insurance options. But an estimated 383,000 people living in Kansas and the other 11 states that have not expanded Medicaid won’t have another affordable option for coverage. That’s because they fall into the coverage gap that exists in nonexpansion states: they make too much money to qualify for Medicaid but not enough money to qualify for Marketplace tax credits that would make buying their own insurance affordable.

“A good chunk of the number (of Kansans) who have remained enrolled will probably fall into that gap,” Steiner said.

Lukens said the process of ending the COVID-19 coverage provisions, referred to as the “unwinding,” could leave even fewer Kansans insured than before the pandemic.

“It’s really important that states take steps now to prevent things like administrative errors from keeping people who are still eligible from being disenrolled, as well as to help people who lose their Medicaid coverage to transition to other coverage,” he said.

Medicaid expansion has been a contentious issue in the Kansas Statehouse. Democrats support it, but the Republican leaders of both chambers have opposed the idea.

“There’s still the opportunity for Kansas to expand (Medicaid) to more than offset any decline in coverage that could occur during the unwinding,” Lukens said.

— Rose Conlon reports for Kansas News Service.