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.

Young People After Obamacare: Some ER Visits Down, Others Way Up

Emergency room visits for adults 19 to 25 dropped slightly after implementation of the Affordable Care Act (ACA). But visits for mental illnesses and circulatory diseases increased significantly, according to a study published online this month in the Annals of Emergency Medicine. Study author Renee Hsia, MD, of the University of California San Francisco said, “Increased health insurance coverage reduced ER visits by young people for conditions that can be treated in office-based settings, but the lack of mental health resources continues to bring these patients to the ER in ever larger numbers. We also saw an increase in patients with diseases of the circulatory system, such as non-specific chest pain. There was a big decrease in ER visits for complications of pregnancy among young people, which is important as it was among the top reasons they visited the emergency room prior to the implementation of the ACA.”

Spending Is Up While Utilization is Down for the Privately Insured

Privately insured Americans used fewer medical services in 2013, but spent more on these services, according a report by the Health Care Cost Institute. There was a 3.9% increase in spending for enrollees of employer health plans, continuing the moderate growth trend that began in 2010. “Price growth for medical services and brand name drugs remained strong in 2013. Health spending grew moderately, but that was only because consumers used fewer services,” said HCCI Executive Director David Newman.

Spending averaged $4,864 per enrollee in 2013, up $183 from the year before. Out-of-pocket costs remained stable including co-payments and deductibles. In 2013, there was a decline in the use of brand prescription drugs, inpatient admissions, and outpatient services. Yet average prices increased for all three categories, and at higher rates than in 2012. Acute inpatient hospital admissions fell 2.3% while prices rose 6.7%, causing inpatient spending to rise 3.8%. The average price per-admission grew by $1,101, in 2013 to $18,030. Outpatient visits declined 0.8% while prices rose 6.4%. Total outpatient visit spending grew 5.5%.

The use of brand name prescriptions (filled days per 1,000 insureds) dropped 15.5% while the average price per filled day grew more than 21.2%. Total spending on brand name drugs grew 2.4%. The use of professional services grew in 2013, including office visits and lab tests. The use of generic prescriptions grew 4.5%. Preventive visits to primary care physicians and contraceptive hormone use both rose 5%. Antidepressants dominated generic prescription drug use, accounting for over 10% of all generic drugs used in 2013.

In 2013, consumers spent an average of $800 out-of-pocket — a 4% increase over 2012. Women 19 to 25 spent an average of $662 out-of-pocket — the same as the year before. This was almost completely due to a drop in out-of-pocket spending on generic and brand hormone contraceptives. Hormone contraceptives are generally covered without cost sharing, a provision of the Affordable Care Act that went into effect January 1, 2013. “This is the first time we have seen flat out-of-pocket spending growth by any group of the privately insured,” said HCCI Senior Researcher Amanda Frost.

In 2013, out-of-pocket spending for medical services went up (especially for acute inpatient admissions), but went down for brand and generic prescriptions. In 2013, women 19 to 54 used more outpatient and professional services compared to men. But after 54, the gender gap narrowed, as mens’ use of radiology, laboratory, and pathology services increased.

Adults 19 to 25 visited the ER more often than did adults 55 to 64. However, older adults had a higher average price for their visits, due partially to use of more intensive care. Spending on ER visits averaged $314 per capita for older adults, compared to $310 for young adults.

Anti-depressants account for 10% of generic drug use. In fact, anti-depressants were the most commonly filled class of CNS generic prescriptions and the most used generic drug class for young men, intermediate men, middle age women, and pre-Medicare women. For more information, visit www.healthcostinstitute.org.

Last Updated 05/25/2022

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