FARGO – Not long ago, Mike Barry was going to a homeless health clinic to take care of his chronic health conditions, which include diabetes, high blood pressure and pulmonary disease.
But about two years ago, he gained access to health insurance because North Dakota expanded its Medicaid program. He's one of almost 19,000 who picked up Medicaid coverage - a big factor in the drop in the uninsured rate in North Dakota, which fell from 15 percent in 2013 to 6.9 percent in the first half of this year, according to a new Gallup survey.
Now the 50-year-old Fargo man has access to a primary-care doctor and a team of specialists, a dietitian and a diabetes coach.
"I know there's been a lot of discussion about the Affordable Care Act," Barry said, referring to the health reform law that allowed states to expand Medicaid and provides health insurance premium subsidies for others. "For me, it's been a godsend. It's opened a lot of doors."
North Dakota is one of the 10 states that has experienced the greatest reduction in the rate of those who are not covered by health insurance from 2013 to 2015, according to the survey.
Over the same period, when the national uninsured rate fell from 17.3 percent to 11.7 percent, Minnesota's uninsured rate decreased from 9.5 percent to 4.6 percent, Gallup reported. Minnesota was one of seven states to fall below 5 percent.
Most states have seen the uninsured rate drop, a trend Gallup attributes to expanded health insurance coverage provided through the Affordable Care Act, often called Obamacare.
The states with the largest decreases in the uninsured rate usually had both expanded Medicaid and created their own exchanges.
Minnesota did both, while North Dakota decided to participate in the federal health insurance exchange.
Adam Hamm, North Dakota's insurance commissioner, offered a guarded assessment of the Gallup figures.
"In my nearly eight years as insurance commissioner, I've seen numerous estimates and surveys regarding the number of uninsured North Dakotans ranging anywhere from 7 percent to 15 percent," Hamm said in a statement. "This survey is simply one more data point to consider."
Another reading on the uninsured population came Wednesday from the Centers for Disease Control and Prevention, which estimates that 11.5 percent were uninsured nationwide in 2014. In North Dakota, the rate was 7.3 percent and 6.5 percent in Minnesota.
Two health insurance executives said they weren't surprised by the sharp drop in the uninsured rate, as portrayed in the trend figures from the Gallup surveys.
In addition to the almost 19,000 who gained coverage through expansion of Medicaid eligibility in North Dakota, another 18,171 are covered through the health insurance exchange, according to figures from March, the most recent available.
That means 36,000 to 37,000 residents in North Dakota recently gained health insurance coverage, said Jeff Sandene, interim president of the Sanford Health Plan, which provides insurance for Medicaid expansion in the state.
"That's a big number," he said. "It really doesn't surprise me," he added, referring to the 8.1-percentage point drop shown by the Gallup surveys. "I didn't know the exact number."
Besides expansion of health insurance through the Affordable Care Act, the strong economy in North Dakota has helped broaden coverage, according to Sandene and Pat Bellmore, chief marketing officer for Blue Cross Blue Shield of North Dakota.
The North Dakota Blues have seen more employers provide health insurance for the first time, Bellmore said.
"A lot of it is the tight labor market," he said. To attract and keep workers, employers must offer competitive benefits, including health insurance, Bellmore added.
Those who previously lacked health insurance now have the benefit of accessing health care, including preventive care that is directed by a primary care physician and carried out by a team of providers, Sandene said.
Barry is a case in point. In addition to his primary-care doctor at Sanford Medical Center, he now sees specialists for his diabetes, kidney problems and leg problems, as well as a diabetes coach and dietitian. A community paramedic visits him once a week to monitor his conditions.
"It's allowed me to access things I wouldn't have had access to," he said.
As a result of the more intensive and coordinated care, Barry's chronic conditions have stabilized and he is seeing some improvement, he said. A 35-year veteran of restaurant work, Barry has been sidelined by his chronic health problems.
"At least I know what the problems are, what I can do, what can be done about it," he said. "It takes the guesswork out."
Bellmore and Sandene expect more individuals to get health insurance through the exchanges, as penalties continue to rise for those who lack coverage - suggesting, they said, the uninsured rate should continue to decline.