New Data Show Estimated Uninsured Rate In 2021 Recovers Slightly From Highs Of 2020

Uninsured rate in 2021 down from the highs of 2020

Source: Fierce Healthcare, by Robert King

An estimated 30 million people did not have insurance coverage last year, bringing the uninsured rate to 9.2%—only slightly below the major high of 9.7% from 2020, new federal data show.

The National Center for Health Statistics released its latest report Thursday on estimates for health insurance coverage last year. The data showed slight gains in insurance coverage from public programs.

The report showed that last year, among adults 18 to 64, there were 13.5% who were uninsured at the time of the interview while 21.7% had public coverage and 66.6% got private insurance.

 
 

Among children up to 17 years old, 4.1% were uninsured, 44.3% had coverage from a public program and 53.8% were in private coverage.

Even though the uninsured rate dipped slightly compared to 2020, there were minimal changes among certain age groups.

For instance, the percentage among adults 18 to 64 didn’t change that much from 2020 (13.9%) to last year at 13.5%. But there was a significant difference between the percentage of adults who were uninsured in 2019, 14.7%, but declined to 13.5% last year.

There was also a boost among adults that had public insurance coverage in 2021, with 21.7% getting such coverage last year compared with 20.5% in 2019.

The increase in public health coverage comes amid major moves by the federal government and Congress to increase affordability of coverage on the Affordable Care Act’s exchanges. Increased subsidies from the American Rescue Plan Act helped spur a record-breaking 14.5 million in sign-ups for the exchanges this year.

Other pandemic-related flexibilities included a boost to federal matching rates for Medicaid coverage and a requirement that states not disenroll anyone from their Medicaid rolls.

However, the eligibility redetermination freeze is expected to last until the end of the public health emergency, which could expire this summer. The enhanced subsidies are also expected to go away after this year, but there is an effort in Congress to extend them.

 

The center emphasized that the report only contains early release estimates that still could change. The estimates are based on data from the 2021 National Health Interview Survey, which is based on information collected from nearly 30,000 adults and 8,293 children.

Data Insights from the 2016 ACA Marketplace

 

ACA


Robert Wood Johnson offers the following observations about the Affordable Care Act Marketplace:

  • Carriers made adjustments in 2016 to reduce their exposure to high costs: In 2016, carriers attempted to minimize their exposure to high costs by reducing the number of plan offerings with out-of-network benefits, among other strategies. This change occurred at all metal levels and in all regions. The number of Silver plans that are HMOs or exclusive provider organizations (EPOs) increased from 61% in 2015 to 69% in 2016. The number of Gold plans declined compared to other metal levels. While the number of Silver plans increased 2.9%, the Gold plans declined by 8.7%. The number of Gold plans declined in most regions.
  • Regional price variation in narrowed: There was a geographic convergence in premium prices in 2016, as premiums rose far more in regions that had lower prices the prior year. Nationally, the distribution of average premium prices tightened in all rating areas. This pattern was less straightforward for deductibles, as many combinations of cost-sharing options are on the market.
  • Price variation increased within markets: Despite the reduced variation across markets, differences in premium prices increased within markets. The average premium price range increased from 2015 to 2016 in a rating area. This is true for all metal levels and all regions. The distribution has become more skewed, as maximum prices increased more than minimum prices. In 2016, a Blue or a national carrier offered the highest priced plan in a rating area about 75% of the time.
  • There are still large regional differences in plan design: Plans in the Northeast and West have a much broader range in premium prices and less variation in deductibles. Plans in the Midwest and South have a smaller range in premium prices and a far greater range in deductibles. There were some changes in these patterns from 2015 to 2016, but there are still important regional differences in plan design.
  • More regulated markets have higher premiums and lower deductibles:  Federally facilitated marketplaces with the most plan regulation—CA, CT, DC, MA, NY, RI, VT—had the highest premiums and lowest deductibles.

More product changes are likely in 2017. There is room for further reduction in broad network plans. Most entrants in 2016 primarily offer narrow network products. This will probably continue to vary regionally. We may also see further reduction in Gold plans, although carriers must sell Gold and Silver. There are indications that some carriers may reduce their Bronze offerings. The number of Bronze plans increased very little in 2016. There may be reductions in some markets in 2017. The actuarial value of Bronze and Silver plans seems to have grown closer in 2016, and average prices are quite close in many regions. While carriers have resisted government calls for standardization and simplification of plan offerings, the industry seems to be standardizing itself through potential reductions in product offerings.

Premium prices will converge further. While premium increases are expected, some regions are relatively under priced. A further reduction in regional differences will probably take place. Prices may converge at the levels seen in more regulated state-based marketplaces, which may be more appropriately priced.

The weaker markets are smaller, largely rural, have less carrier participation in 2016, fewer plans, and lower premiums. These markets may experience higher premium increases and continued low carrier participation, which will inhibit enrollment gains.

UnitedHealth Group announced that it will exit 26 markets and participate in three. The company has not announced a decision about five others. In states where UnitedHealth Group is exiting, the insurer was priced relatively lower than others, and there tended to be a higher-priced Blue plan in the marketplace. Exit states weak markets with fewer plans, less growth in the number of plans, a smaller range in premium prices, and below average premiums—despite average or above average premium increases from 2015 to 2016.

UnitedHealth Group may have concluded that, due to the small size and low level of activity in certain markets, there would not be enough additional enrollment to offset negative claims experiences, and that it would be hard to raise premiums enough to stop losing money with enrollees. If other carriers follow suit, weak markets may become weaker as they lose carriers and/or experience above average price increases. Humana seems to have positions in weak markets and is priced relatively low in many of them. Humana’s decisions about exiting markets suggests that it may be seeking to reduce its presence in weak markets.

One-Third of Doctors Consider Quitting After Passage of the ACA

Thirty-six percent of all doctors, and 45% of private practice doctors say they are more inclined to leave the medical profession because of the Affordable Care Act (ACA), according to a study by CompHealth. Fifty-one percent of doctors surveyed view the ACA unfavorably while 30% view it favorably. Physicians in private practice are most pessimistic, with 61% saying they view the law negatively. Doctors also say the following about practicing medicine after the ACA:

  • 47% say the ACA has improved access to healthcare and insurance.
  • 44% say the ACA has had a neutral effect on their patients’ quality of healthcare.
  • 76% of all doctors, and 86% of private practice doctors say they are not properly compensated by ACA reimbursements.
  • 38% say their salaries have decreased.
  • 44% spend less time with their patients.
  • 68% spend too much time entering data.
  • 59% spend too much time doing paperwork.

To cope with challenging circumstances, 40% of doctors are supplementing their income by filling in for other doctors, moonlighting, and consulting.

Last Updated 05/25/2022

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