The number of uninsured Americans under age 65 declined by an additional 1 million people in 2016, three years after the major insurance reforms of the Affordable Care Act (ACA) took effect, according to a new federal survey of 94,000 people released by the U.S. Census Bureau today (Exhibit 1). Using data from the Current Population Survey (CPS), Census reported that 10.1 percent of the U.S population under age 65, or 27.5 million people, were uninsured in 2016, down from 15.3 percent in 2013 (Exhibit 2).
Young Adults Continue to Make the Strongest Gains in Coverage
Uninsured rates declined across all age groups in 2016, with the greatest gains among young adults. The uninsured rate among adults ages 19–25 dropped by 1.4 percentage points in 2016 to 13.1 percent, the largest one-year drop of any age group (Exhibit 2). But Census notes sharp differences in the percentage of people uninsured at different ages, reflecting the fragmented nature of the U.S. health insurance system. For example, 26-year-olds have the highest uninsured rate of any age, at 17.5 percent, which is one-and-a-quarter times greater than the rate for 25-year-olds. This drop-off in coverage at age 26 likely reflects adult children aging off their parents’ insurance policies and experiencing some time without insurance. Similarly, the uninsured rate jumps at age 19, a long-term problem that likely continues to stem from children aging off traditional Medicaid or the Children’s Health Insurance Program (CHIP), particularly in those states that have not expanded their Medicaid programs. At the other end of the age spectrum, the uninsured rate drops sharply at age 65 when people become eligible for Medicare.
Uninsured Rates Edged Down Across Racial and Ethnic Groups
Latinos continue to be the most likely of racial and ethnic groups to lack health insurance. After experiencing the largest coverage gains of any group in prior years, gains were more modest in 2016 (Exhibit 3). The uninsured rate among African Americans has dropped sharply since 2013, but continues to exceed that of whites.
The Uninsured Rate Among People with the Lowest Incomes Fell the Most in 2016
People with low and moderate incomes have historically had the highest rates of uninsurance, largely because they are the least likely to have insurance through a job and could not afford to buy coverage on their own. The ACA’s marketplace subsidies and Medicaid expansion were concentrated on helping people in this income range gain coverage, and their uninsured rates continued to fall in 2016. However, marketplace subsidies are less generous among people with incomes over 250 percent of poverty, or about $30,000 for an individual. In 2016 there was a slight uptick in the uninsured rate among those earning between 250 percent and 399 percent of poverty, or about $48,000 for an individual (Exhibit 4).
States with Above-Average Uninsured Rates Have Not Expanded Medicaid
The Census also released new data from the massive American Community Survey of 3.5 million people, which provides estimates of health insurance coverage at the national, state, metropolitan, and county levels, and by congressional district. There were significant declines in uninsured rates in 2016 in 39 states. The change since 2013 is dramatic (Exhibit 5). In 2013, 19 states had uninsured rates of more than 14 percent for the full U.S. population; in 2016 only one state, Texas, had an uninsured rate that high. Montana, which expanded eligibility for Medicaid in 2015, experienced a drop in the uninsured rate of 3.5 percent in 2016, the largest of any state. Of the 20 states that had not expanded eligibility for Medicaid under the ACA as of January 2016, 17 had uninsured rates that exceeded the national average. (Louisiana has since expanded its program.)
Looking Forward
Today’s new Census report shows that the ACA’s coverage expansions have helped increase the share of the U.S. population under age 65 with insurance coverage to about 90 percent in 2016. With the ACA’s open enrollment beginning in less than two months, a report released last week from the Commonwealth Fund offers insight into why some 28 million people remain uninsured. Based on new survey findings, the report finds that two of five uninsured working-age adults remain unaware of the marketplaces, with rates highest among groups with the highest uninsured rates (Exhibit 6). The report also found that personal assistance matters in the enrollment process. Adults who received some kind of assistance, such as through a broker or navigator or by calling a helpline, were more likely to enroll than those who didn’t get assistance (Exhibit 7). With as many as 60 million insured or uninsured people dependent on the ACA for their access to health care, it is critical that federal and state policymakers remain committed to helping people maintain and enroll in the coverage they are eligible for this fall.