Uninsurance Rises to 8.5%, First Major Increase Since ACA Passed

September 12, 2019 - In 2018, 8.5 percent of the nation did not have health insurance coverage at any point during the year, the Census Bureau’s report revealed, arguably the first rise in the uninsurance rate since the Affordable Care Act passed other than a 0.1 percent rise in 2017.

The number is the result of a new method of counting uninsurance rates which intends to reduce underreporting, the Center on Budget and Policy Priorities (CBPP) noted. It does so, in part, by asking respondents both what their current healthcare coverage status is and what it has been over the course of the year. Reframing the question this way enables the census to better capture an individual’s overall health insurance experience.

The census arrived at a 0.5 percentage point increase in uninsurance from 2017 when both were modified to account for underreporting of coverage, CBPP pointed out.

Medicaid expansion, race, and age were key factors in the uninsurance rate increase, the report revealed.

The census showed that the uninsured rate was lower in states that expanded Medicaid when compared to states that have not yet expanded.

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Under the expanded Medicaid programs, the uninsurance rate was 6.6 percent, consistent with last year’s findings. In non-expansion states the average uninsurance rate rose slightly to 12.4 percent.

Eleven states experienced significant shifts in their uninsurance rates. Of those, five had expanded their Medicaid programs under the Affordable Care Act in 2014 or 2015.

One expansion state (New York) and two non-expansion states (South Carolina, Wyoming) experienced significant uninsurance rate decreases. The rest of the states with significant shifts saw increases in uninsurance.

Studies have indicated that Medicaid expansion does not necessarily increase access to care for all demographics, in particular for Hispanic patients. The census suggests that this problem persisted in 2018.

Hispanic patients experience the most challenges in receiving healthcare coverage of any demographic. Around 18 percent have no health insurance coverage. About half of the 82.2 percent who do have coverage are under a public payer. Both private and public insurance rates for the Hispanic population dropped in 2018 by around one percent.

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Black patients saw the highest number of publicly insured individuals at 41.2 percent. Overall, 90.3 percent of this demographic had health coverage.

Asian patients were the least likely to be on public insurance, with only 26.1 percent publicly insured. They also have the second highest rate of insurance at 93.2, only 1.4 percent behind non-Hispanic white patients.

Non-Hispanic white patients had the highest rate of insurance (94.6 percent) and the highest private insurance rate at 74.8 percent. They also had the second lowest rate of public insurance.

Legal immigrants to the United States still face a high rate of uninsurance. Of those who indicated that they were foreign-born, the overall health insurance rate dropped by 1.6 percent, entirely from private insurance. Public insurance rates for this group stayed the same.

Age was likewise a strong indicator of the likelihood of insurance. Individuals aged 65 and older were 99.1 percent likely to be covered, mostly by Medicare, whereas 88.3 percent of those aged 19 to 64 had health insurance. More specifically, adults between 19 and 25 were the least likely to be insured.

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Children ages 19 and under had the highest rate of coverage in 2018, apart from those aged 65 and older, 94 percent of whom fall under Medicare coverage.

But the insured children population saw decreases of around one percent in both private and public coverage, with private coverage dropping to 61.8 percent and public insurance decreasing to 35.7 percent of the population under 20.

Separate data echo these findings. A study released in May 2019 revealed that CHIP and Medicaid enrollment fell by 2.2 percent in 2018, raising questions about the fate of the children who disenrolled. The census provided more context for this number.

The decrease in public coverage was a result of the Medicaid and CHIP disenrollment, the report stated.

Uninsurance among children was higher in 2018 at 5.5 percent, but the rate varied based on demographic.

“In both years, the percentage of children without health insurance coverage decreased as the income-to-poverty ratio increased,” the report explained.

In addition to income, geography and race were factors influencing uninsurance rates in children. With 7.7 percent of Southern children facing uninsurance, this demographic had the highest uninsurance rate and saw an increase of 1.2 percent from the previous year. Hispanic children saw a one percent rise in uninsurance and white children saw a 0.5 percent increase.

Many of the changes in insurance rates have been directly related to controversial policy changes, the report noted.

The success of Medicaid expansion is tied to the strength of the Affordable Care Act, which is now facing potential repeal again.

The coverage status of different minority groups, particularly Hispanics, has been linked to the administration’s new immigration policies such as the recently passed public charge rule.

The strong percentage of privately insured individuals in the older population may point to the success of Medicare Advantage. Experts at a teleconference hosted by Georgetown University Health Policy Institute blamed the eligibility and enrollment process as well as the public charge rule for the fall in CHIP and Medicaid disenrollment.

As Congress goes back into session, healthcare policy is expected to take up a central position in their debates.