Fact Sheet

The Impact of Medicaid Expansion in Virginia on Uninsured LGBT Adults

June 2018

In May 2018, Virginia became the 33rd state to expand Medicaid under the Affordable Care Act when the Virginia General Assembly voted to extend eligibility to households earning up to 138 percent of the federal poverty level.

AUTHORS
Fact Sheet

Virginia’s decision to expand Medicaid eligibility could make up to 21,000 lesbian, gay, bisexual, and transgender (LGBT) adults (age 18-64) eligible for health insurance.1 Approximately 42,000 LGBT adults22, 19%3 of LGBT-identified individuals are currently uninsured. In comparison, approximately 14.5% of non-LGBT adults age 18-64 in Virginia are uninsured (approximately 751,000 uninsured non-LGBT adults). The new Virginia state budget, signed by Governor Ralph Northam on June 7, 2018, incorporated Obamacare Medicaid expansion rules, including expanding Medicaid eligibility to households earning up to 138% of the federal poverty level.4Virginia is the 33rd state to adopt these expansion rules; under these rules, an estimated 49.3% of uninsured LGBT Virginians (approximately 21,000), along with 53.4% of uninsured non-LGBT Virginians (approximately 401,000), may now become eligible due to meeting the expanded income requirement.5

In addition, voter initiatives to expand Medicaid are expected to appear on the November ballots in three additional states: Nebraska, Idaho, and Utah.6 Should voters approve expansion in all three states, up to an additional 17,000 LGBT adults age 18 to 64 (and 285,000 additional non-LGBT adults) could potentially gain health insurance through the Medicaid program.7

Data Source: 2012-2017 Gallup Daily Tracking Survey

The Impact of Medicaid Expansion in Virginia on Uninsured LGBT Adults

Some adults who are now eligible due to expanded income criteria may include some adults who were previously eligible through other criteria, but who did not previously enroll in Medicaid.

Between 2012 and 2016, approximately 5,300,000 adults age 18 to 64 lived in Virginia, as estimated by 2012-2016 American Community Survey 5-year estimates. For total 18-64 state population estimates: Search American Fact Finder (https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml), last visited June 6, 2018. Select ‘Advanced search,’ enter “Age” under ‘Topic,’ select ‘State’ + ‘All States within United States and Puerto Rico’ under ‘Geographies,’ and select ‘Sex by Age: 2012-2016 American Community Survey 5-year Estimates’ for source data.

Health insurance status was assessed via responses to the question “do you have health insurance coverage” (yes/no) on the Gallup Daily Tracking Survey. In the survey, 19.0% of the 18-64 year old LGBT respondents in Virginia (and 14.8% of the non-LGBT respondents in Virginia) answered “no” and were categorized as uninsured. This proportion was applied to the computed estimated number of LGBT (4.2%) and, separately, non-LGBT Virginians age 18 to 64, and rounded to the nearest 1,000.

In unpublished analyses conducted by the Williams Institute, 4.2% of Virginia adults age 18-64 who responded to the Well-Being Index track of Gallup Daily Tracking Survey between June 2012 and December 2017 identified as LGBT, by answering “yes” to the question ‘do you personally identify as lesbian, gay, bisexual, or transgender”? This proportion was applied to the ACS population estimates to derive the estimated number of LGBT adults, weighted using Gallup state survey weights (which allow estimates to be nationally representative of the US population) and rounded to the nearest 1,000.

Goodnough, A. (2018, May 30). After Years of Trying, Virginia Finally Will Expand Medicaid. The New York Times. Retrieved June 6, 2018 from https://www.nytimes.com/2018/05/30/health/medicaid-expansion-virginia.html; Vozzella, L. (2018, June 7). Northam signs Medicaid expansion into law on steps of Virginia Capitol. The Washington Post. Retrieved June 7, 2018 from https://wapo.st/2kU23qg?tid=ss_mail&utm_term=.e3c529539f4e

Of the 18-64 year old LGBT Virginia Gallup Daily Tracking respondents who were uninsured, 49.3% reported household incomes ≤138% of the federal poverty level. Following the approach to measuring poverty outlined by the Census Bureau (https://www.census.gov/topics/income-poverty/poverty/guidance/poverty-measures.html), household poverty was computed by first determining the household size by summing the self-reported number of adults and children under age 18 living with the respondent. Total household income was self-reported as categories (<$720 / $720 to $5,999 / $6,000 to $11,999 / $12,000 to $23,999 / $24,000 to $35,999 / $36,000 to $47,999 / $48,000 to $59,999 / $60,000 to $89,999 / $90,000 to $119,999 / ≥$120,000), which were recoded to the midpoint of each range. The highest income bracket (”≥$120,000”) was recoded to the lower end of the range of top 5% incomes for the respondent’s survey year, as estimated by the Current Population Survey Annual Social and Economic Supplement (https://www.census.gov/data/tables/time-series/demo/income-poverty/cps-hinc/hinc-05.html); as 2017 estimates were not available at the time of this writing, 2016 estimates were used for 2017.

To determine if household income met the Medicaid expanded poverty threshold, the ratio of household income to the annual weighted household size-specific poverty thresholds from the year respondent was surveyed (https://www.census.gov/data/tables/time-series/demo/income-poverty/historical-poverty-thresholds.html; preliminary thresholds used for 2017) was computed, and dichotomized as ≤138% (aka Medicaid eligible) vs. >138% (Medicaid ineligible). This proportion was applied to the computed estimated number of uninsured LGBT Virginians age 18 to 64 (see above), and rounded to the nearest 1,000.

Kaiser Family Foundation. (2018, May 31). Status of State Action on the Medicaid Expansion Decision. Retrieved June 6, 2018 from https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/

Additional eligible LGBT computed following the same procedure outlined above, based on ACS 202-2016 population estimates for Utah (1,748,000; 4.0% Gallup respondents identified as LGBT), Nebraska (1,142,000; 4.1% Gallup respondents identified as LGBT), and Idaho (971,000; 3.8% Gallup respondents identified as LGBT).

In Nebraska, up to 3,000 LGBT adults would be eligible for health insurance under expanded eligibility criteria, computed based on unpublished Gallup Daily Tracking analyses that found 20.7% of 18-64 year old LGBT were uninsured, 34.0% of whom reported household incomes ≤138% the FPL. In addition, up to 76,000 non-LGBT adults could gain coverage, computed based on 15.4% of 18-64 non-LGBT were uninsured, 45.2% of whom reported household incomes ≤138% the FPL.

In Idaho, up to 4,000 LGBT would be eligible for health insurance under expanded eligibility criteria, computed based on unpublished Gallup Daily Tracking analyses that found 25.7% of 18-64 year old LGBT were uninsured, 45.9% of whom reported household incomes ≤138% the FPL. In addition, up to 95,000 non-LGBT adults could gain coverage, computed based on 19.9% of 18-64 non-LGBT who were uninsured, 51.2 of whom reported household incomes ≤138% the FPL.

In Utah, up to 10,000 LGBT adults would be eligible for health insurance under expanded eligibility criteria, computed based on unpublished Gallup Daily Tracking analyses that found 22.1% of 18-64 year old LGBT were uninsured, 63.2% of whom reported household incomes ≤138% the FPL. In addition, up to 114,000 non-LGBT adults could gain coverage, computed based on 15.0% of 18-64 non-LGBT were uninsured, 45.4% of whom reported household incomes ≤138% the FPL.