text: 4.6 percent of VT population uninsured
  According to the latest figures from the U.S. Census Bureau, 28,000 Vermonters, 4.6 percent of the state's population, were uninsured at some time during 2017. Some of those people could have been uninsured because they were between jobs or for some other reason were uninsured for part of the year. Others were uninsured for the entire year. And some may actually have been insured but didn't realize it when the Census Bureau employee came knocking at their door asking questions.
  That percentage is somewhat misleading because just about everyone over the age of 65 is covered by Medicare. A more relevant statistic is the percentage of Vermont's population under 65 without health insurance, which is 5.5 percent. A bit higher, but still pretty low. Only three states—Massachusetts, Hawaii, and Minnesota—have lower percentages than Vermont. For the nation as a whole, 10.2 percent of the under 65 population was uninsured at some time in 2017.
  The Patient Protection and Affordable Care Act, also known as Obamacare, dramatically reduced the percentage uninsured. Nationally it fell from 17 percent just before the Great Recession to 10.2 percenttoday and in Vermont from 10 percent to 5.5 percent over the same period.
  Vermont has had fewer people uninsured than the nation for a long time. On the surface, it appears that Vermont policies to make it easier for people to have coverage through Medicaid, the government's health insurance program for low income people, may be part of the reason.
  Thirty percent of Vermonters under the age of 65 get their health insurance through Medicaid compared to 22 percent for the nation. Only four states have a higher percentage than Vermont — New Mexico, West Virginia, Louisiana, and Arkansas—all among the poorest states in the nation. Vermont is not a poor state. There is clearly something different about Vermont's high share of people insured through government programs.
  When such a large number of people get their health care paid for by government funds, it shows up in the budget. Although roughly half of Medicaid's cost is borne by the federal government, half comes from the state, at a budgetary cost of about $700 to $800 million annually. My ballpark estimate is that our higher-than-average Medicaid caseload costs the state about $200 million per year.
  That cost needs to be balanced against the benefit that people get from having health insurance. We don't, unfortunately, know whether in the absence of liberal state enrollment policies those people would be uninsured or if they would be insured through employer-provided health insurance plans.
  From the late 1980s through 2007, just before the Great Recession, the percentage of Vermonters who were uninsured bounced around, but there was no clear trend up or down. But in the late 1980s, before many of Vermont's policies to reduce the number of uninsured were implemented, only about 11 percent of Vermonters received their health insurance through Medicaid.
  By the late 1990s that had increased to 20 percent, with no appreciable change in the total number of Vermonters who were uninsured. By the eve of the Great Recession, 24 percent of Vermonters were covered by government insurance plans, more than twice the share 20 years earlier.
  What happened over that two-decade period was that many Vermonters switched from employer-provided health insurance to Medicaid, funded from taxpayer dollars. That may be because Medicaid provided cheaper or better insurance than the private insurance people had. Or it may be because employers saw it as a way to cut their costs by eliminating health insurance benefits to their workers, knowing they would be eligible for the state program. The cost savings to employers could have been shared by the employer, in the form of higher profits, and the employees in the form of higher wages.
  Whatever the reason, Vermont does have a low percentage of its residents who are uninsured. Whether that percentage would be the same or higher without the government spending so much of its resources is an open question.