HHS: Uninsured Rates Decline For Younger Americans From 2019 Through 2021

HHS: Uninsured rates decline for younger Americans

Source: Fierce Healthcare, by Robert King

More Americans in key demographics that have been historically uninsured saw coverage gains from 2019 through 2021, a new federal report finds.


The Department of Health and Human Services (HHS) released a report Friday detailing gains in coverage from 2019 through 2021. Officials attributed a decline in the uninsured rate from 11.1% in 2019 to 10.5% in 2021 due to expansions in Medicaid and other gains via the Affordable Care Act’s (ACA’s) marketplace.


“We know that access to quality, affordable healthcare is key to healthier lives, economic security, and peace of mind” said HHS Secretary Xavier Becerra in a statement. “As we move forward, [HHS] will continue to do everything we can to protect, expand and strengthen the programs that provide the quality, affordable healthcare Americans rely on and deserve.”

The report found that the decline in the uninsured rate in 2021 was the largest among people with household incomes between 100% and 250% of the federal poverty level. In 2021, the White House engaged in a special enrollment period as well as enhanced and expanded premium tax credits.

The enhanced credits were recently extended through 2025 as part of the Inflation Reduction Act passed last year.


Those credits helped lower the cost of insurance for low-income ACA consumers and are a key driver of record enrollment of 15.9 million people for the latest 2023 open enrollment.

There were also larger gains in coverage among demographic groups that had high uninsured rates historically.

For example, adults ages 19 to 34 and 35 to 49 uninsured rates both declined by one percentage point. Latino individuals also saw the uninsured rate decline by one percentage point.

The gains in coverage varied at times between states, with ones that expanded Medicaid under the ACA having the largest increases.


Maine saw the largest decline in its uninsured rate by 3.2 percentage points from 2019 through 2021. Idaho came in second with 2.1 percentage points during the same time period.

Researchers analyzed data from 2019 and the newly released 2021 American Community Survey, which surveys Americans on several topics including insurance coverage.

The report also investigated the reasons people go without health coverage.

“The most common barrier cited by people without insurance is cost, with more than 70% of uninsured people reporting that health coverage was unaffordable,” the report said.

It remains unclear what impact upcoming changes could leave on uninsured rates, especially among those who got coverage via Medicaid.

States have not dropped anyone off Medicaid since early 2020 in exchange for a boost to its federal matching rate payment for Medicaid. The continuous coverage requirement was supposed to run through the COVID-19 public health emergency, but Congress passed a law late last year that enabled states to start Medicaid eligibility redeterminations this April.

Employer-Sponsored Coverage Flatlined Even As Unemployment Rate Shrunk: Study

Employer-sponsored health insurance flatlined during early COVID

Source: Fierce Healthcare, by Frank Diamond

While unemployment rates have declined since the early days of the pandemic, enrollment in employer-sponsored coverage has remained largely stagnant, a new study shows.


Why? Because the public health emergency made it easier for many people to enroll in Medicaid coverage or in plans on the Affordable Care Act’s exchanges. Preparing for those flexibilities to go away is critical, researchers wrote in a study published this week in Health Affairs.


Medicaid eligibility rules were relaxed during the pandemic to ensure coverage for as many individuals as possible. That’s going to change soon. The recently passed omnibus bill set a deadline of April 1 to begin the redetermination process.

“The loss of Medicaid through redetermination is a qualifying life event for a special enrollment period in either the ACA Marketplace or employer-sponsored coverage, and people losing coverage have a limited time in which to enroll in a new plan,” the study said. “Policymakers and employers should be prepared to help people who lose Medicaid eligibility identify and navigate enrollment in alternative sources of health insurance, including both Marketplace and employer-sponsored coverage.”

Researchers examined data extracted every one to two weeks by the Census Bureau’s Household Pulse Survey, which randomly selects participants from the Census Bureau’s Master Address File. The surveys collected data from 57,000 to 81,000 respondents per week, with response rates ranging from 5.3% to 7.5%. The survey period ran from Jan. 26, 2022, to Feb. 7, 2022.


Despite a rising employment rate during 2021, researchers said the rate of employer-sponsored insurance did not go up.

“Overall, employer-sponsored coverage has remained remarkably consistent throughout the pandemic,” the study states. “We found that enrollment in Medicaid and other public sources of coverage was responsible for the overall increases in coverage at a national level.”

Those other public sources of coverage included the ACA Marketplace plans, the Children’s Health Insurance Program and the Consolidated Omnibus Budget Reconciliation Act.

“We estimated that eight million people gained coverage during this period, primarily through sources other than employer-sponsored insurance,” the study states.


When asked by Fierce Healthcare if public spending on Medicaid will likely increase because of the role Medicaid played during the pandemic, the study’s corresponding author, M. Kate Bundorf, Ph.D., of Duke University, responded that “redetermination is likely to lead to fewer people enrolled in Medicaid since many people are likely no longer eligible, so public spending is not likely to increase due to the redetermination process.”

Bundorf said that one of the difficulties in mining the data involved trying to pin down exactly who were the Medicaid beneficiaries. “This is an issue with survey data,” Bundorf says. “People sometimes have a hard time answering questions about their insurance coverage correctly.”

No dramatic differences in enrollment across demographic groups occurred, according to the study. In states that had expanded Medicaid, coverage increases could be mostly seen in adults aged 27 to 50, and those increases were not driven by employer-sponsored coverage. Hispanics were the exception, where coverage increases were employer driven.

“In nonexpansion states, relatively few of the effects in subgroups were statistically significant, likely in part because of the relatively small size of the nonexpansion state population,” the study said. “Notable exceptions include statistically significant gains in any coverage among Black people, primarily in the form of employer-sponsored coverage. Among Hispanic people in nonexpansion states, in contrast, we found no evidence of an increase in any coverage but found that the stability in any coverage was the result of a shift away from employer-sponsored coverage that was offset by an increase in other sources of coverage.”

The researchers also looked ahead at how redetermination might play out. The study states that “many people currently enrolled in Medicaid, particularly in expansion states, might no longer qualify as a result of higher income from employment. Although some current Medicaid enrollees may have access to employer-sponsored coverage, it is unclear how many workers will have such access.”

Bundorf says that although there is a lot of work being done on the redetermination process, “I can’t point you to anything specific on state efforts to make people aware of their options.”

Last Updated 01/25/2023

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