Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Ty Borders, Ph.D.

Committee Member

Julia Costich, MPA, JD, Ph.D.

Committee Member

Glen Mays, Ph.D.



With the individual mandate of the Patient Protection and Affordable Care Act (ACA) set to go into effect in 2014, as well as the Medicaid expansion in some states, the federal and state governments have a difficult road ahead planning how to respond to the anticipated increase in health services use. Kentucky is an undecided state regarding the Medicaid expansion and as one of the more impoverished states in the U.S. potentially has much to gain from the new law.

Many studies have focused on the U.S. as a whole in describing the health status of the uninsured. This paper focuses on a state level analysis of the uninsured in Kentucky to give state policy makers, as well as other Kentucky health care workers and organizations, some insight into the population’s health status. Demographic information is also presented to describe the uninsured population and understand how the composition of the uninsured differs from the insured, as well as to give insight into the scope and proportion of health care costs and premiums the federal and state governments will be responsible for in covering the newly insured.

The most recently available data from the American Community Survey (2011) and the Behavioral Risk Factor Surveillance System (2010) are used to describe the demographic makeup and health status of uninsured Kentuckians as compared to the insured. Results indicate that the uninsured have lower levels of access to doctors, checkups and preventive screening; have a higher prevalence of self-reported poor mental health as well as poor or fair self-reported general health; exercise less frequently than the insured; and are more likely to be current smokers. Hispanics, blacks and other racial minorities are more vulnerable to being uninsured, as are the young and less educated. Unemployment is high and full-time work less common among the uninsured when compared to the insured. Most of the uninsured will qualify either for Medicaid (if the expansion is taken in Kentucky) or for federal subsidies though the health exchange after the mandate goes into effect. These results imply that those soon to be insured are very different and likely less healthy than the currently insured and thus their health services utilization may be very different as well after ACA implementation.

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