Category: State Talk

In 2022, several studies of trends in health insurance coverage found generally good news: since the Affordable Care Act became law in 2011, the percentage of Americans without health insurance coverage has dropped from 15.1 percent to 9.2 percent in 2019 – an improvement likewise seen in all Midwestern states.

Laws passed in response to the COVID-19 pandemic – the Families First Coronavirus Response Act of 2020 and the American Rescue Plan Act of 2021 – helped drive the percentage of uninsured Americans even lower from 2019 to 2021 in most states.

But those same studies noted continuing disparities in who is covered and found that questions about affordability remain. Here are four trends of note in Midwestern states.

Coverage has improved since 2011, but unevenly

The percentage of uninsured people fell in all Midwestern states in the 10 years since the Affordable Care Act became law in 2011, and fell further from 2019 to 2021, except in Kansas and North Dakota, according to the U.S. Census Bureau.

In North Dakota, the percentage actually rose from 6.9 percent in 2019 to 7.9 percent in 2021 while in Kansas, it stayed flat, at 9.2 percent.

The Census Bureau attributes variations in states’ rates over the 10-year period to factors like differences
in age of the population, economic conditions, and policy changes like the ACA’s Medicaid expansion option for states.

All Midwestern states but Kansas, South Dakota and Wisconsin had adopted this expansion before 2022. From 2011 to 2021, Kansas’ uninsured rate fell from 12.6 percent to 9.2 percent, South Dakota’s from 11.9 percent to 9.5 percent, and Wisconsin’s from 9 percent to 5.4 percent.

But expansion states’ rates dropped by more: Indiana’s fell from 14.5 percent to 7.5 percent, Minnesota’s from 8.8 percent to 4.5 percent, Michigan’s from 11.8 percent to 5 percent, and Illinois’s from 13.1 percent to 7 percent.

Additionally, the Rural Policy Research Institute at the University of Iowa says two federal policy decisions stabilized uninsured rates during the pandemic:

• The Families First Coronavirus Response Act prevents states that accepted enhanced Medicaid funding for the public health emergency from reviewing Medicaid recipients’ status until after the emergency is officially rescinded.
• The U.S. Department of Health and Human Services opened health insurance marketplaces for most of 2021 instead of the usual annual Nov. 1 to Jan. 15 enrollment period.

Private, employer-based insurance covers most people

Whether employer-provided or purchased from an insurance company or on a public exchange, private insurance covered the majority of Midwesterners in 2021. Employer-provided health insurance provides the bulk of this coverage, ranging from a low of 57.9 percent (Kansas) to a high of 61.5 percent (Minnesota).

Among public programs, Medicaid covers more people than Medicare in Illinois, Indiana, Iowa, Michigan, Minnesota and Ohio — all states that adopted Medicaid expansion.

Medicaid covers between a fifth and a quarter of people in Michigan (23.5 percent), Ohio (21.5 percent), Iowa (20.4 percent) and Indiana (20.1 percent). Medicaid coverage rates for other Midwestern states range from 12 percent in North Dakota to 19.7 percent in Illinois.

In South Dakota, where Medicare covers 18.4 percent of residents compared to 13.7 percent under Medicaid, voters in November approved an initiated constitutional amendment adopting Medicaid expansion. The state’s Department of Social Services estimates about 52,000 newly eligible residents will enroll once expansion has been implemented.

South Dakota is also one of the Midwestern states in which direct purchase of insurance from an insurance company or an exchange is most prevalent — that option covers 18.1 percent of residents, second only to North Dakota (18.5 percent).

Direct purchase rates in Nebraska (16.8 percent) and Minnesota (16.7 percent) are also higher than the other Midwestern states, where direct purchase ranges from 15.9 percent in Kansas to 12.1 percent in Ohio.

But overall coverage rates vary by age, race

Nationwide, uninsured rates vary widely by age — partly as a function of Medicare and programs targeting younger children — and race, according to an American Community Survey brief released in November.

Medicare covers those ages 65 and older, while children under age 19 may be included in their parents’ insurance coverage, Medicaid and/or the Children’s Health Insurance Program.

For example, no Midwestern state’s uninsured rate for adults ages 65 and older is even 1 percent.

At the other end of the age spectrum, for those under 19 years of age, uninsured rates in the Midwest range from 3 percent in Michigan and 3.2 percent in Illinois to 7.3 percent in North Dakota.

While those ages 19 to 26 are eligible to be covered by their parents’ policies, Midwestern states’ uninsured rates among adults ages 19 to 64 range from 7.1 percent in Michigan to 13.3 percent in South Dakota and 13.5 percent in Kansas.

The ACS brief also found a wide coverage gulf persisting between Whites and Asians on one end of the range and Hispanics and Native Americans at the other. Nationally, just 5.7 percent of Whites and 5.8 percent of Asians were uninsured in 2021 compared to 9.6 percent of Blacks, 17.7 percent of Hispanics and 18.8 percent of Native Americans.

Within the Midwest, the percentages for White uninsured range from 3.4 percent in Minnesota to 6.9 percent in Kansas; for Black uninsured, from 7.4 percent in Wisconsin to 20.3 percent in North Dakota; for Asian uninsured, from 4.2 percent in Michigan to 9.6 percent in Ohio.

The percentages for Hispanic uninsured range from 10.1 percent in Michigan to 20.1 percent in Nebraska and 20.3 percent in Kansas; and for Native Americans, from 12.5 percent in Michigan to 35 percent in South Dakota.

“Racial differences in health insurance coverage persisted across age and selected characteristics and reflect disparities in social determinants of health, such as income and poverty status as well as employment,” the brief says.

Rising costs of insurance still a major obstacle

Coverage alone doesn’t help if the insured person can’t afford treatment. Reports issued earlier this year by The Commonwealth Fund suggest health insurance costs are taking larger bites out of middle-income families’ budgets and leaving them “underinsured.”

A September study found more than two in five working adults ages 19 to 64 were underinsured, defined as someone to whom at least one situation applies:

• Out-of-pocket costs over the prior 12 months, excluding premiums, were equal to 10 percent or more of household income.
• Out-of-pocket costs over the prior 12 months, excluding premiums, were equal to 5 percent or more of household income for individuals living under 200 percent of the federal poverty level ($27,180 for an individual or $55,500 for a family of four in 2022).
• The deductible constituted 5 percent or more of household income.

A January study of state trends in employer premiums and deductibles from 2010 to 2020 found that in 2010, worker contributions to insurance premiums and deductibles made up 10 percent of median income in no Midwestern state. By 2020, they did in all but Michigan and Minnesota.

“The high cost-sharing people face in many employer, individual-market, and marketplace plans is primarily driven by the prices that providers, especially hospitals, charge to commercial insurers and employers,” the latter report says. “These prices are the highest in the world. And consumers bear the burdens.”

The post State of health coverage in the Midwest: Four takeaways from studies showing a drop in uninsured, but continued disparities and rising costs appeared first on CSG Midwest.

Ohio: New tax credits target help for beginning and retiring farmers

Ohio has joined the list of Midwestern states that use tax incentives to help beginning farmers. For these individuals, the state is offering a tax credit to offset the costs of participating in a financial management program.

But Ohio Rep. Susan Manchester notes the recently enacted HB 95 isn’t just for individuals starting their agricultural careers; generations that came before them will benefit as well. That’s because a provision in the law offers an income tax credit to a business or individual who sells or rents farmland, livestock, buildings or equipment to them. “The legislation was designed [in part] for those farmers who are ready for their retirement, facing a big capital gains tax if they sell the farm or equipment,” says Manchester, a sponsor of the bipartisan legislation.

The program will run for five years, with the total amount of tax credits capped at $10 million. Manchester says these limits will allow for an analysis of HB 95’s effectiveness before any extension of the program. “There are so many barriers to beginning and successfully managing a farm today; this is just one step to helping preserve the legacy of Ohio’s family farms,” Manchester says. The credit is equal to 3.99 percent of the sales price or gross rental income. (The credit is 3.99 percent because that is Ohio’s highest tax rate.)

Here are other examples of state-level help for beginning farmers.

Nebraska’s Beginning Farmer Tax Credit program is the longest-standing program of its kind in the Midwest; it began in 1999 and provides a tax credit equal to 10 percent of the cash rent or 15 percent of the value of the crop-share rent for three years.
In 2007 Iowa established a 5 percent tax credit for cash rent leases and a 15 percent credit for crop-share leases. • Minnesota provides a tax credit of 5 percent of the sale price, 10 percent of the cash rent income or 15 percent of a cash-share agreement. The Minnesota program started in 2018.

Minnesota: $500,000 grant program provides down-payment assistance for beginning farmers

With this year’s passage of HF 3420, the Minnesota Legislature is appropriating a total of $500,000 in FY 2023 in down-payment assistance — through a grant program (up to $15,000 per recipient) for first-time Minnesota farm owners earning less than $250,000 per year in agricultural sales.

Only individuals (not LLCs or partnerships) that provide the majority of labor and management on the farm are eligible.

“It’s a capital-intensive business, and for people who don’t come from a family farm in particular, it can be difficult to get started,” notes Minnesota Rep. Paul Anderson, a longtime agriculture producer himself.

In exchange for the grant, an individual is expected to match it and to farm the purchased land for a minimum of five years. Nearly all Minnesota farmers are White, with an average age of 56. The down-payment program aims in part to bring more diversity to the farm sector and help younger people become farmers; that is why only smaller-scale farmers are eligible for the $15,000 grant. That amount will be significant for someone growing specialty crops such as vegetables or berries (as opposed to row-crop or livestock producers).

Kansas: Legislators adopt new sales tax exemption to aid in fencing repair, replacement

In December 2021, western Kansas experienced strong winds that toppled power lines, sparking wildfires that damaged more than 163,000 acres. Under the state’s law at the time, legislators would have to take proactive action to help farmers recover from natural disasters like this one by offering tax assistance related to the repair or replacement of fencing. 

The initial idea of Kansas Sen. Elaine Bowers and others: Amend statutory language so that this sales tax exemption applied to all future natural disasters. (Future legislative action would not be needed.)

Bowers says the reach of the measure expanded during Senate deliberations. 

Under the final agreed-upon version (signed into law as part of the broader HB 2239), all sales of tangible property and services used to build or repair any fence enclosing agricultural land is now exempt from the state sales tax. 

Iowa: For retired farmers, state offers new tax exemption on income from renting or leasing land

Iowa’s HF 2317, signed into law in March 2022, made headlines for gradually moving the state to a flat income tax rate. The measure also exempted net capital gains on the sale of employee-awarded capital stock.

For farmers, too, the new law included targeted tax relief.

“[It’s] part of efforts to make government more effective and efficient, while providing benefits to rural residents,” Iowa Sen. Ken Rozenboom says. “For the third time in recent years, we have lowered taxes, and this new legislation provides farmers with an opportunity for tax exemption in retirement.”

With HF 2317 in place, retired farmers can exempt the income they receive from renting out or leasing farmland. A person must be 55 or older and no longer actively farming. He or she also must have owned the property and been active in the farming business for at least 10 years. (Farmers operating as a partnership, LLC or corporation may not claim the exemption.)

As state Rep. Lee Hein notes, the inclusion of this statutory language address the needs of “farmers whose land serves as their retirement.”

Separate provisions in HF 2317 help other Iowa retirees, through the elimination of taxes on income from pensions and retirement accounts, for example, and the capital gains exemption. The new law also modified an existing capital gains income exemption that applies to farmers when they sell property or cattle, horses or breeding livestock. (Individuals may not claim both the capital gains exemption and the farm lease exemption.)

 

 

The post appeared first on CSG Midwest.

A record number of women will be serving in U.S. state legislatures in 2023, holding close to one-third of the seats in capitals across the country, according to the Center for American Women and Politics at Rutgers University.

In the Midwest, Illinois will have the highest percentage of state legislative seats held by women: more than 40 percent (exact totals in Illinois were uncertain as of early December due to two too-close-to-call legislative races). Three other states in the region eclipse the national rate of 32.2 percent: Michigan, Minnesota and Nebraska (see map).

In terms of representation in state legislatures, the greatest gains for women during the 2022 election cycle occurred in Indiana, Michigan, Minnesota, Nebraska and North Dakota. Between 2022 and 2023, the number of female legislators will fall in two Midwestern states: Ohio (-2) and South Dakota (-1).

Across the country this year, a record number of women were major-party nominees for state legislature (3,615), the center notes. Two states, Colorado and Nevada, now have majority-women legislatures, and 12 of the nation’s 50 U.S. governors (24 percent) are women, including Iowa Gov. Kim Reynolds, Kansas Gov. Laura Kelly, Michigan Gov. Gretchen Whitmer and South Dakota Gov. Kristi Noem. (All four of them were re-elected to office in 2022.)

In the U.S. Congress, women now hold a record-high 27.9 percent of the seats.

The post The number of women in U.S. state legislatures is on the rise, including in most Midwestern states appeared first on CSG Midwest.

Illinois Sen. Elgie Sims has joined a select group of state legislators and governors leading The Council of State Governments. He will serve as vice chair in 2023, and is in line to be chair-elect in 2024 and CSG chair in 2025.

In July, Sims was nominated by his peers in CSG’s Midwestern Legislative Conference to join the national leadership team. That nomination was approved in December at the CSG National Conference by the nonpartisan group’s Executive Committee.

A member of the Illinois General Assembly since 2012, and current chair of the Senate Appropriations Committee, Sims served for four years as an MLC officer, including as chair in 2019. (CSG Midwest provides staff support to the MLC.)

Sen. Sims continues to be an active member of the MLC Executive Committee, and also is a 2014 graduate of its Bowhay Institute for Legislative Leadership Development, or BILLD, and a 2015 graduate of CSG’s Toll Fellowship Program.

In 2022, Wisconsin Sen. Joan Ballweg served as CSG past national chair and Kansas Gov. Laura Kelly as CSG past president.

 

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