September 15, 2022
Taking the High Road: New Census Data Shows How Virginians Fared Better Due to Medicaid Expansion, and the Need for More Targeted State Choices
This post has been updated to correct median household income data.
New data released from the U.S. Census Bureau’s American Community Survey (ACS) offer a picture of how Virginians fared in 2021, including health insurance coverage, household income, and poverty rates – separate from the assistance provided by tax credits, stimulus payments, or non-cash benefits. On average, Virginia children and families saw higher official poverty rates and stagnant real (inflation-adjusted) household incomes in 2021 compared to 2019. With the exception of unemployment insurance, the direct impact of federal relief for families such as improved tax credits and food assistance are not captured in ACS poverty and income data because of the types of survey questions used. The Supplemental Poverty Measure data released previously included that data and showed that during 2021, federal and state investments shielded many Virginia families from severe hardship and helped shorten the country’s economic crisis (see TCI statement).
In particular, Virginia’s choice in 2018 to expand Medicaid has served as a critical safety net for Virginians during the pandemic, and Virginia residents are now significantly less likely to be uninsured than their neighbors in non-expansion states. And federal improvements to broad-based programs like the child tax credit and unemployment insurance helped drive down the share of Virginians who were struggling to make ends meet in 2021. As certain federal choices have already or will expire, state lawmakers should make targeted choices in the upcoming legislative session to protect the progress that was made and improve access to comprehensive health coverage and economic security for Virginia families.
The new data show that, relative to 2019:
- An additional 193,195 Virginia residents gained health insurance. The share of Virginians without health insurance has dropped to 6.8%, down from 7.9% in 2019.
- Looking longer term, since Virginia’s expansion of Medicaid was implemented in January 2019, 682,762 Virginia adults have gained health coverage through Medicaid expansion, and the share of Virginians without health insurance has dropped 2 full percentage points, down from 8.8.% in 2018.
- The share of Virginians without health insurance is now significantly lower than in our neighboring states that have not yet expanded Medicaid.
- Health insurance coverage gains in Virginia have been particularly significant for Black and Latino/a/x Virginians. Native American and multiracial individuals saw a jump in the uninsured rate from 2019 to 2021. Native American, Latino/a/x, and multiracial Virginians remain uninsured at rates higher than the state average. All documented changes in the uninsured rate by race/ethnicity were statistically significant aside from those of Asian Americans in Virginia.
- Uninsured rates in Virginia continue to vary significantly by immigration status. Non-citizens, including lawful permanent residents, refugees and asylees, and many other possible statuses, are much more likely to not have health coverage, with an uninsured rate of 33%, compared to their U.S.-born (5.1%) and naturalized citizen (8.1%) counterparts.
- Virginia children experienced a 0.1% increase in the official (cash-only) poverty rate. Virginia’s 2021 cash-only child poverty rate of 13.1% remains significantly below the cash-only national child poverty rate of 16.9%.
- Virginians overall experienced a 0.3% increase in the cash-only poverty rate. As with the child poverty rate, Virginia’s cash-only poverty rate of 10.2% is significantly lower than the national poverty rate of 12.8%.
- Barriers to educational and employment opportunities, such as residential segregation, mean that a higher share of Black and Latino/a/x Virginians compared to the state average have incomes below the official poverty threshold. Smaller sample sizes mean that the relatively small changes in poverty rates from 2019 to 2021 are not statistically significant for most race and ethnicity groups.
- Data released Tuesday shows that Virginia’s supplemental poverty rate, which is a more comprehensive measure of family well-being than the official poverty measure, dropped to 8.6% for the three-year period of 2019-2022, down from 11.5% during the 2017-2019 period. This drop was greater than the decrease in the estimated official poverty rate using the same Current Population Survey release, showing the importance of federal COVID relief and other policy choices that are captured in the supplemental poverty measure but not the official poverty measure. The supplemental poverty measure includes in a family’s income the value of tax credits and non-cash benefits such as food assistance (SNAP), and also adjusts for geographic costs of living and expenses such as medical and child care costs.
- Virginia households did not see a statistically significant change in median household income in 2021 compared to 2019 after adjusting for inflation. Virginia’s median household income in 2021 was $80,963. In 2019, the median household income was $81,025 after adjusting to 2021 purchasing power.
- The median household income for Virginians who are Latino/a/x and multiracial increased in 2021 compared to 2019, while other race/ethnicity groups did not see a statistically significant change in median household income. As with official poverty rates, Census estimates of median household income do not include the major improvements in the Child Tax Credit and health insurance subsidies in 2021 compared to 2019.
Virginia’s improved health insurance coverage and reduction in the more comprehensive supplemental poverty rate were driven by policy choices such as the improved federal Child Tax Credit, Virginia’s expansion of Medicaid, federal COVID-related Medicaid coverage protections, and Affordable Care Act marketplace subsidies. Unfortunately, the improvements to the Child Tax Credit have already ended, and the COVID protections for Medicaid coverage are likely to end in early 2023. Virginia policymakers wisely improved the state Earned Income Tax Credit this year, which will help some families in early 2023 when they file their 2022 taxes.
Virginia policymakers can protect and build on Virginia’s improved health insurance coverage rates by making sure Virginia’s Department of Medical Assistance Services has the resources to contact and communicate with eligible and currently enrolled Virginia residents so they are not removed from Medicaid access due to paperwork problems. Lawmakers can also respond to health coverage disparities by immigration status by removing immigration-related barriers to health coverage for children.
With less federal help for families this year due to the end of the improvements to the Child Tax Credit, it is likely that child poverty rates will increase in 2022. Virginia policymakers can build on the recent improvements to Virginia’s Earned Income Tax Credit by making the credit fully refundable, thereby delivering the full benefit to qualifying working families with children. Additionally, Virginia could consider creating a state Child Tax Credit to increase family stability and child outcomes.Virginia policymakers have made key choices in recent years to expand opportunities and invest in the future. This includes improving funding for K-12 education, removing barriers to Medicaid access, raising the minimum wage, and making Virginia’s Earned Income Tax Credit partly refundable. These good choices, combined with federal policy improvements, have increased opportunity, increased the share of Virginians with health insurance and reduced poverty rates using the more comprehensive supplemental poverty measure. In 2018, Virginia was the worst state in the country for working people according to OxFam America. Today, Virginia is an above-average state, ranking 22nd out of 50. Let’s keep taking the high road and keep making Virginia better for all of us.
Economic Opportunity, Health Care