Less than a decade after one of the worst recessions in modern American history, the U.S. Census Bureau reported this summer that household incomes are up, poverty is down and uninsurance has hit a record low.
On Sept. 13, the Census Bureau released its annual “Income and Poverty in the United States: 2015” and “Health Insurance Coverage in the United States: 2015” reports, announcing that between 2014 and 2015, 3.5 million fewer people were living in poverty and 4 million more people gained health insurance, resulting in the lowest uninsurance rate on record.
In particular, the nation’s official poverty rate in 2015 was 13.5 percent, a 1.2 percentage point decrease from 2014 and the largest annual percentage point drop since 1999. Median household income went up 5.2 percent between 2014 and 2015, from about $53,700 to about $56,500, while the uninsurance rate dropped from 10.4 percent in 2014 to 9.1 percent in 2015.
“This is terrific news — the (Affordable Care Act) is working as it was intended to work,” Sabrina Corlette, JD, a research professor at the Georgetown University Center on Health Insurance Reforms, told The Nation’s Health. “Clearly, we have an unprecedented decline in people who lack coverage and we’re starting to see emerging evidence that expansion of coverage is leading to better health outcomes and better financial health for a lot of people.”
The Census Bureau reported that in 2015, real median incomes for both family and other households increased by more than 5 percent each, representing the first annual increase in median household income for family households since 2007. Still, the 2015 median household income was 1.6 percent lower than before the recession in 2007. Real median household income increased for Hispanic households by 6.1 percent between 2014 and 2015, as well as among white and black households by more than 4 percent each.
Also in 2015, both men and women saw the first significant annual increase in median earnings since 2009. However, the median earning for women who worked full-time year-round was 80 percent of that of comparable men.
The number of families living in poverty dropped from 9.5 million in 2014 to 8.6 million in 2015. Poverty declined among both men and women, though women still experienced higher poverty rates than men across age groups. Poverty decreased among all racial groups, except Asians: Among whites, poverty decreased from 10.1 percent to 9.1 percent; among Hispanics, from 23.6 percent to 21.4 percent; and among blacks, from 26.2 percent to 24.1 percent. Asians in the U.S. did not experience a statistically significant change in poverty. Also between 2014 and 2015, poverty decreased among all major age groups, and poverty among children younger than 18 dropped from just more than 21 percent, to 19.7 percent.
The Census Bureau also released a Supplemental Poverty Measure in September, which found Social Security and refundable tax credits, such as the Earned Income Tax Credit, had the biggest impacts on poverty, preventing 26.6 million and 9.2 million people, respectively, from falling into poverty. On the other hand, out-of-pocket medical expenses had the greatest impact in terms of driving people into poverty.
Julia Isaacs, MPP, a senior fellow with the Urban Institute and a visiting scholar at the University of Wisconsin-Madison Institute for Research on Poverty, called the new Census Bureau poverty numbers a “relief,” considering the steep increase in poverty during the recession and years of stagnation. However, she said that while child poverty declined, the 2015 rate still means that nearly one in five U.S. children are poor, “which is just too many.”
“We’re a rich country with a strong economy and that’s why I think we have the capacity to do better on child poverty,” she told The Nation’s Health. “But when I look at the overall trends, I’d say things are getting better.”
In regard to health insurance, the Census Bureau reported that the percentage of people with health insurance for all or part of 2015 was at 90.9 percent, an increase from 89.6 percent in 2014.
The number of people without insurance dropped from 33 million, or 10.4 percent, to 29 million, or 9.1 percent. Rates of both private and government health insurance increased from 2014 to 2015, with private coverage increasing 1.2 percentage points to just more than 67 percent, and government coverage increasing by less than a percentage point to 37.1 percent. Employer-based insurance covered the most people, followed by Medicaid, Medicare, direct-purchase coverage and military health care.
Among population groups, uninsurance declined for children younger than 19, and insurance coverage rates increased among Hispanics, Asians and whites, with Hispanics experiencing the largest increase at 3.6 percentage points between 2014 and 2015. There was no statistically significant difference in insurance coverage among black Americans. In 2015, whites had the lowest uninsurance rate among racial groups, and Hispanics had the highest, at more than 16 percent.
While praising the new statistics, Georgetown’s Corlette said that sustaining the good news will require continued vigilance. For example, she noted that shopping for and purchasing insurance in the marketplace can be a complicated process and so continued investments in enrollment assistance are critical, noting that “if we don’t step up and do more to fund outreach and enrollment assistance, we could see a reversal of our gains.” She also called for improving marketplace affordability and subsidies for people between 250 percent and 400 percent of poverty, as such households often pay premiums that are fairly high relative to their incomes.
On the issue of affordability, a U.S. Department of Health and Human Services analysis released in August found that in the hypothetical scenario of all marketplace premiums increasing by 25 percent next year, 73 percent of consumers would still be able to buy insurance for less than $75 a month.
The new insurance statistics look different when broken down by state. The Census Bureau reported that in 2015, the lowest uninsured rate was in Massachusetts, at 2.8 percent, and the highest in Texas, at 17.1 percent. Not surprisingly, the Census Bureau also found that states that expanded Medicaid eligibility typically had lower uninsurance rates than states that did not expand Medicaid. In fact, an August report from HHS found that expanding Medicaid lowers marketplace premiums by about 7 percent.
As of summer 2016, Texas was one of 19 states that had yet to expand Medicaid and changing that policy remains an “uphill battle,” said Anne Dunkelberg, MPA, director of the Health and Wellness Program at the Center for Public Policy Priorities in Austin, Texas. Until then, a significant number of Texans will continue to fall into the gap between Medicaid eligibility and qualifying for marketplace subsidies, she said. Dunkelberg also noted that because the state of Texas is providing no support for marketplace outreach and enrollment, federal support for marketplace outreach remains essential.
Still, Dunkelberg said the ACA has benefitted Texas, with the state’s uninsurance rate dropping by 5 percentage points since 2013. Before the ACA, Texas had gone more than a decade without a single percentage-point improvement in its uninsured numbers.
“It’s tremendous news and evidence that ACA implementation is making a huge difference in people’s lives,” she told The Nation’s Health.
For more information on the new census reports, visit www.census.gov.
- Copyright The Nation’s Health, American Public Health Association
