Rate of uninsured Americans continues to drop, data show: Bigger decreases yet to come, experts say =================================================================================================== * Natalie McGill Uninsured rates in the U.S. dropped in 2013, with nearly 87 percent of Americans insured even before state and federal health insurance marketplaces opened last October, according to new data from the U.S. Census Bureau. The drop shows that Affordable Care Act reforms — such as young adults being able to stay on their parents’ insurance until age 26 — continue to make a difference in access to care. And other findings show there may be bigger decreases to come. ![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/44/9/1.1/F1.medium.gif) [Figure1](http://www.thenationshealth.org/content/44/9/1.1/F1) Uninsured patient Patricia Breto receives dental care at a Remote Area Medical free clinic in Bristol, Tennessee, in April 2012. About 42 million Americans were uninsured in 2013, according to the latest estimate from the U.S. Census Bureau. Photo by Mario Tama, courtesy Getty Images About 271 million Americans had health insurance in 2013, while an estimated 42 million Americans, or 13.4 percent, were uninsured, according to “Health Insurance Coverage in the United States: 2013,” released Sept. 16. Just over 24 percent of Hispanics lacked insurance, followed by about 16 percent of blacks and nearly 10 percent of whites, the data said. Census data for 2012 revealed that 48 million Americans were uninsured, but changes to the survey questions for 2013 mean the numbers are not directly comparable, according to the Census Bureau. But while those rates may not be comparable from year to year, data from a second measure from the U.S. Census Bureau — the American Community Survey — are, and the survey’s Sept. 18 findings confirm a drop in uninsurance rates. According to the community survey, which focuses only on Americans living in areas with populations of at least 65,000, the percentage of respondents without health insurance declined from 14.8 percent in 2012 to 14.5 percent in 2013. The new rate is below the 14.6 percent uninsurance rate recorded by the American Community Survey at the start of the recession in 2008, White House staff noted in a Sept. 16 administration blog post. “That recovery in insurance coverage is thanks in significant part to the dramatic expansion in insurance coverage among young adults since 2010...and some states’ early expansions of Medicaid,” according to the post. Under the Affordable Care Act, states were encouraged to expand Medicaid to more residents, allowing coverage for millions of Americans. As of September, 27 states and the District of Columbia expanded Medicaid, while 21 had not and two states were still in discussion in how to proceed, according to the Kaiser Family Foundation. A total of 13 states saw a “statistically significant increase” in the rates of insured residents from 2012 to 2013, according to the American Community Survey: Alaska, California, Colorado, Michigan, Missouri, Montana, Nevada, North Carolina, Ohio, Oklahoma, South Carolina, Texas and Wyoming. The data also looked at uninsured rates in the 25 of the largest U.S. metropolitan areas, finding that uninsured rates were as low as 4.2 percent in Boston and 7.5 percent in Pittsburgh. In the Baltimore metropolitan area, where uninsured rates were at 8.7 percent, contributing factors include an improved state economy where formerly uninsured residents found coverage with employment, said Christopher Garrett, director of communications for the Maryland Department of Health and Mental Hygiene. Additionally, the state had an early start in expanding Medicaid coverage prior to the opening of the health insurance marketplace in October, Garrett said. “People discover they qualify for previously available Medicaid coverage and ‘come out of the woodwork’ to access health care services,” Garrett said. “Outreach was performed to make potentially eligible Marylanders aware of Medicaid expansion as well.” However, uninsured rates were as high as about 25 percent in Miami and nearly 23 percent in Houston, the data said. Eleven metropolitan areas had uninsured rates larger than the average of all 25 metropolitan areas, said Sara Collins, PhD, vice president for the Health Care Coverage and Access Program at the Commonwealth Fund. “What I did find striking about those data is in 11 cities that had uninsured rates that exceeded the average of that group of 25 cities, seven are cities in states that have yet to expand their Medicaid programs,” Collins said. Some states face political roadblocks in their respective state legislatures in getting expansion, Collins said. Arkansas, Iowa, Michigan and Pennsylvania all have approved waivers from the Centers for Medicare and Medicaid Services to use a different approach to expand eligibility for their Medicaid programs, Collins said. “Indiana has a waiver under review and Utah and New Hampshire have waivers under development,” Collins said. “Tennessee is also looking for a way to move forward. I think over time we probably will see states continuing to break through political barriers and expand eligibility for their programs.” While the American Community Survey showed a drop in the number of uninsured children from 7.2 percent in 2012 to 7.1 percent in 2013, the drop was not significant compared to previous declines, according to a statement from Marian Wright Edelman, president of the Children’s Defense Fund. From 2008 to 2012, the uninsured rate declined from 9.3 percent to 7.2 percent, according to the survey. “Between 1997 and 2012, the rate of uninsured children was cut in half, thanks largely to strong coverage guarantees in Medicaid and the Children’s Health Insurance Program, which together last year provided comprehensive health and mental health coverage to more than 44 million children,” Edelman said in a Sept. 18 news release. “CHIP now faces a very real threat. If Congress doesn’t take action, there will be no new funding for CHIP this time next year. Millions of children could lose health coverage, and millions more would pay more for less coverage.” ## Health coverage data from 2014 promising On the heels of the 2013 Census Bureau data was a Centers for Disease Control and Prevention survey showing early signs of success in getting Americans insured in 2014. Between January and March, 13.1 percent, or 41 million Americans, were uninsured, according to a CDC National Health Interview Survey report that was released Sept. 16. The number of uninsured Americans younger than 65 fell from 44.3 million in 2013 to 40.7 million over the three month period in 2014, according to CDC. Among adults age 18-64 in the same timeframe, uninsured rates fell from 20.4 percent to 18.4 percent — a decline of 3.8 million uninsured adults, said Collins of the Commonwealth Fund. For children younger than 18, there were no significant differences in the uninsured rate, but there were large gains among young adults. In states that expanded Medicaid coverage, the percentage of adults ages 18 to 64 who were uninsured dropped from 18.4 percent in 2013 to 15.7 percent in the first three months of 2014, the report said. However, there was little decrease in the uninsured rate in states that did not expand. The CDC report does not reflect the late increase of insurance sign up numbers in March as the enrollment period ended. Eight million Americans signed up for plans in the first enrollment period, according to the Health Resources and Services Administration. The second enrollment period begins Nov. 15, and the Congressional Budget Office projects 19 million more people will gain insurance in 2015, according to April estimates. For more information, visit [www.census.gov](http://www.census.gov) and [www.cdc.gov/nhis](http://www.cdc.gov/nhis). * Copyright The Nation’s Health, American Public Health Association