By Glenn Howatt, Star Tribune

The share of Minnesotans without health insurance fell to a record low last year, as new provisions of the Affordable Care Act kicked in with a historic expansion in the nation’s insurance markets.

Just 5.9 percent of the state’s population was uninsured in 2014, giving Minnesota the fifth-lowest rate in the nation, according to the U.S. Census Bureau’s annual report on income and insurance.

That was a sharp drop from 2013, when 8.2 percent of Minnesotans lacked health insurance. Nationwide, the uninsured rate fell from 13.3 percent in 2013 to 10.4 percent last year.

The dramatic drop came as more consumers used state and federal online insurance exchanges to buy coverage and tax penalties loomed for those who lacked health insurance at the beginning of this year.

The numbers were greeted as vindication of the controversial federal law, especially by elected officials who embraced it early.

“This dramatic drop in the number of Minnesotans without health insurance is an indisputable success of MNsure and the Affordable Care Act,” Gov. Mark Dayton said in a statement. “It means better, more affordable health care for them and their families, and lower, indirect health care costs for everyone else.”

But critics noted that the number of people getting health insurance through employers has been relatively flat.

“Everybody is acting like it is a surprise that handing out more government health care is resulting in a drop in the uninsured,” said Sen. Michelle Benson, R-Ham Lake. “It is a government program; it is not because people are getting more and better jobs.”

Since November, more than 325,000 Minnesotans have signed up for health insurance using the state’s MNsure exchange. The vast majority landed in Medical Assistance or MinnesotaCare, public health insurance programs that now cover one of every five Minnesotans. About 70,000 Minnesotans signed up for private plans on the exchange, with more than half receiving premium public subsidies.

Minnesota Human Services Commissioner Lucinda Jesson said that although government insurance rolls are growing, the state will benefit from a healthier population.

“We have differences on how to bring down health care costs and sign up the remaining uninsured, but overall we’ve had bipartisan support for the idea that it serves us all when all people have health care,” Jesson said

Still, 317,000 Minnesotans remained without health insurance, according to the figures released Wednesday.

Jesson said the state will continue outreach efforts to groups that historically lack coverage. “The targeted outreach to communities that we are doing is making a difference,” Jesson said. “By continuing to really push that process we will see the numbers come down even further.”

Every state improves

Every state in the nation recorded a significant decrease last year in the rate of those without health insurance. Texas, with the highest rate, dropped from 22.1 percent to 19.1 percent uninsured. Massachusetts, which stood as the model for the federal health reform law, had the lowest rate at 3.3 percent.

Between 2008 and 2013, Minnesota’s uninsured rate hovered around 8 to 9 percent. But in 2014, the number of uninsured shrank by 123,000 people.

The decline was unprecedented, said Elizabeth Lukanen, deputy director of the State Health Access Data Assistance Center at the University of Minnesota. “I can’t think of another time when we’ve seen a reduction of that size in a single year.”

If Minnesota’s uninsured rate continues to decrease, census data show that the state’s public insurance programs are likely to keep growing. Of the remaining uninsured, about half have incomes that could qualify them for Medical Assistance, the state’s version of Medicaid.

Uninsured rates remain high, however, in Minnesota’s minority communities. Black Minnesotans had an uninsured rate of 15 percent, American Indians were at 23 percent and Hispanics were at 29 percent, census figures for Minnesota showed.

Portico Healthnet, a St. Paul-based nonprofit that helps people enroll in insurance, said the need for its services has not decreased. In July, it assisted 1,110 people, down slightly from the 1,253 in July 2014.

“We did see an uptick in folks coming to us earlier this year because they didn’t realize that they were going to have to pay a penalty,” said Rebecca Lozano, outreach director. Some people seek help because they don’t speak English, are new to the state or don’t understand how health insurance works.

Also uninsured are undocumented immigrants, who are not eligible for public programs or any health insurance sold on the MNsure exchange.

Michael Scandrett, a consultant who works with the Minnesota Health Care Safety Net Coalition, said studies estimate that undocumented immigrants comprise about 15 percent of the uninsured population.

“While people have different views on the immigration debate, the fact remains that there are kids who get sick and don’t have coverage when that happens,” said Scandrett.