Census: US adult uninsurance rate has dropped to new low: Affordable Care Act credited for decline
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* Natalie McGill

More than 89 percent of adult Americans had health insurance coverage in 2014, according to recent Census Bureau data. And that drop can be linked directly to Affordable Care Act health care reforms.

The uninsured rate fell from 13.3 percent, or nearly 42 million people, in 2013 to 10.4 percent, or 33 million people in 2014, according to the bureau’s “Health Insurance Coverage in the United States: 2014” report released Sept. 16. Overall, there were 283 million U.S. adults with health insurance in 2014, compared with 271 million Americans in 2013.

![Figure1](http://www.thenationshealth.org/https://www.thenationshealth.org/content/nathealth/45/9/1.2/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/45/9/1.2/F1)

Metropolitan Family Health Network counselors Stephanie Lee, left, and Payal Shah, center, talk to Stephanie Ruiz about health insurance coverage options in October 2013 in Jersey City, New Jersey. U.S. uninsurance rates dropped in 2014.

Photo by Andrew Burton, courtesy Getty Images

“The report also showed no evidence of reduced coverage, which is what ACA opponents told us would happen,” said Ron Pollack, JD, executive director of health care advocacy group Families USA in a Sept. 16 news release. “This report demonstrates that they were wrong, and it’s time for the fearmongering to end. Now, we must build on this success to make the ACA even better by pushing for greater value in health care and making sure people aren’t discouraged from seeking care because of unreasonable deductibles and out of pocket costs.”

Asians, blacks and Hispanics saw their uninsured rates drop since 2013 by just over 4 percent to 9.3 percent, nearly 12 percent and nearly 20 percent, respectively. The uninsured rate for whites in 2014 was 7.6 percent, a 2.1 percent drop from 2013.

The biggest changes in health insurance rates were due to coverage gained through direct purchases, which include state and federal health insurance marketplaces, and through Medicaid, according to the report. Direct purchase coverage increased by 3.2 percent, from 11.4 percent in 2013 to 14.6 percent in 2014. The percentage of people covered by Medicaid for part or all of the year increased by 2 percent from 17.5 percent to 19.5 percent.

Open enrollment for the health insurance marketplace officially began in October 2013. Open enrollment for coverage in 2016 will kick off Nov. 1 and end Jan. 31, 2016.

“I think this really is pretty strong evidence that the Affordable Care Act is having its intended effect of reducing the number of Americans who don’t have health insurance coverage,” said Sara Collins, PhD, vice president for the Health Care Coverage and Access Program at the Commonwealth Fund. “We saw strong gains in this survey among people who are the most at risk of being uninsured. Young adults in particular made very strong gains in 2014 — about 3.5 million 19 to 34 year olds gained coverage…and then there were also gains among racial and ethnic minorities and people with low incomes. These were the intended targets of the Affordable Care Act: people who lacked health insurance through a job and couldn’t afford a plan if they had to buy one on their own.”

Between 2013 and 2014, uninsured rates across all 50 states and the District of Columbia dropped between a range of 0.4 percent to 5.8 percent. However, whether states expanded Medicaid made the difference in just how many people were getting coverage. One provision of the Affordable Care Act was the option for states to expand Medicaid coverage to adults younger than age 65 whose incomes are up to 133 percent of the federal poverty level.

In 2014, the uninsured rate was 9.8 percent for states that expanded Medicaid compared to 13.5 percent in states that did not expand Medicaid coverage.

As of September, 30 states and the District of Columbia have expanded Medicaid, according to the Henry J. Kaiser Family Foundation. Nineteen states are not expanding coverage and one state is still discussing the possibility of expansion, according to the foundation.

The state with the highest number of uninsured residents is Texas at 19.1 percent, which has not expanded Medicaid. The lowest rate is in Massachusetts, which did expand its coverage, at 3.3 percent.

“We’ll likely continue to see states move forward as they break through some of the political challenges they’ve had in expanding Medicaid for their residents,” Collins told *The Nation’s Health.* “These estimates which show such major differences in states that haven’t and those that had really puts a fine point on why the expansion is so important. I think that many states will work hard going forward to expand eligibility for their programs. This is one of the barriers to insuring the remaining people uninsured.”

Major U.S. metropolitan areas are continuing to make progress in making affordable health care a reality for residents, according to the latest state- and community-level data from the Census Bureau’s 2014 American Community Survey released Sept. 17. The survey, which features data on communities with populations of 65,000 people or more, found that private coverage increased in 36 states, and in 18 out of 25 of the biggest U.S. metropolitan areas. One of the largest increases in private coverage was in the Miami metropolitan area, which increased from 50.5 percent to 54.7 percent from 2013 to 2014, according to census data.

“We’re improving but we have so much room to improve and the issues are Medicaid and people in the coverage gap,” said Laura Brennaman, PhD, RN, CEN, policy and research director for Florida Community Health Action Information Network, a Florida health care advocacy group. “We’re going to implore decision-makers in high places to listen to their constituency and do something about getting access to the people that need it.”

Brennaman praised navigators — people who assist the public in finding health coverage — in the Miami metropolitan area for spreading the word about health insurance marketplace enrollment. During the same week the census data came out, she and her network organized and facilitated a Florida Assister Network and Learning Summit where 100 assisters, such as navigators, from around the state met to discuss boosting their ability to get more Floridians enrolled in the health insurance marketplace and get high quality health care.

For more information on the Current Population Survey and the American Community Survey, visit [www.census.gov](http://www.census.gov).

*   Copyright The Nation’s Health, American Public Health Association