Uninsurance rates for Americans dropped nearly across the board from 2015 to 2016, with young adults experiencing particularly strong gains in health insurance coverage, according to new data from the U.S. Census Bureau.
In September, the agency released two annual reports: “Health Insurance Coverage in the United States: 2016” and “Income and Poverty in the United States: 2016.” According to the findings, the uninsured rate for Americans dropped to a record low of 8.8 percent in 2016, down from 9.1 percent in 2015. Meanwhile, adults ages 19-25 experienced the biggest declines in uninsurance among all age groups, with uninsurance rates dropping 1.4 percentage points in 2016 to 13.1 percent, according to the Commonwealth Fund.
Among other notable findings from the census reports, which cover 2015 to 2016:
real median household incomes increased 3.2 percent, from $59,039 to $57,230;
the real median incomes of non-Hispanic white, black and Hispanic households increased by 2 percent, 5.7 percent and 4.3 percent, respectively;
the percentage of Americans with health insurance coverage increased from 90.9 percent to 91.2 percent;
the percentage of Americans lacking health insurance coverage declined for most people under age 65, with working-age adults 19 to 64 generally experiencing bigger declines; and
whites had the lowest uninsured rate, at 6.3 percent, compared with 10.5 percent for blacks, 7.6 percent for Asians and 16 percent for Hispanics.
Disparities in health insurance coverage were also apparent when comparing states. The Census Bureau data showed that Massachusetts, which expanded Medicaid eligibility under the Affordable Care Act, had the lowest percentage of people without health insurance, at 2.5 percent. Texas, which did not expand Medicaid, had the highest, at 16.6 percent. Other states with high rates included Florida, Georgia and Oklahoma, none of which have expanded Medicaid.
By population area, the health insurance coverage rate was 91.6 percent for people in metropolitan areas and 90.5 percent for people outside them.
The significant gains in coverage for young adults in particular continue an upward trend since ACA enrollment began in 2013.
“Especially when we look at it historically, young adults were uninsured at the highest (rate) of all age groups pre-ACA, and we’ve seen that uninsured rate just drop in half,” Erin Hemlin, MA, national director of training and consumer education at Young Invincibles, told The Nation’s Health.
The ACA made it easier for young adults to attain health insurance coverage in several ways. For example, the passage of the law allowed adults up to age 26 to remain on their parents’ health insurance plans, which “had an immediate effect on uninsurance rates in the first year of the rollouts,” said Sara Collins, PhD, vice president of health care coverage and access at the Commonwealth Fund.
The policy also provided a safety net for young adults who are often employed in positions that do not offer employer-sponsored health insurance coverage, as noted by the Centers for Medicare and Medicaid Services. Further, 1 in 6 young adults has a chronic illness, while about half of uninsured young adults struggle to pay their medical bills, according to CMS.
But perhaps the greatest factor in enrolling more young people was the expansion of Medicaid eligibility in many states throughout the U.S., according to Collins. Young people, especially those from historically underserved minority groups, have disproportionately high enrollment in Medicaid.
“The marketplaces tend to get a lot of the attention, but the Medicaid expansion has been equally, if not more, important, given the demographics of young adults,” Collins told The Nation’s Health.
It is crucial that young people continue to enroll in health insurance coverage to sustain the federal marketplace. Recognizing the need to keep young people enrolled to keep costs down and ensure the strength of the health insurance marketplace, federal agencies under President Barack Obama last year took on a new push to reach uninsured young adults, kicking off with the Affordable Care Act Millennial Outreach and Engagement Summit in September 2016.
As part of the effort, CMS also developed a social media outreach campaign in partnership with a number of organizations to get the word out to young adults about marketplace coverage.
“The Obama administration made a significant effort with this age group in terms of advertising and outreach,” Collins said. “It was viewed as a very important group not only because uninsurance rates were very high, but also because enrollment for this age group would benefit the risk (pool),” Collins said.
However, this year presents new challenges for enrollment. In July, President Donald Trump’s administration ended contracts in 18 cities to provide Affordable Care Act assistance. In August, CMS announced that the administration would cut enrollment advertising by 90 percent, from $100 million in 2016 to $10 million in 2017. The budget for navigators who help people sign up for health insurance coverage was also slashed from $62.5 million to about $36 million. Such shortfalls in outreach are compounded by a shorter open enrollment period. Further, the Healthcare.gov website will be down for maintenance for 12 hours each Sunday during open enrollment.
“There’s a lot of concern and uncertainty right now about what’s going to happen,” Rachel Garfield, PhD, MHS, senior researcher and associate director for the Program on Medicaid and the Uninsured at the Kaiser Family Foundation, told The Nation’s Health.
Without a concerted advertising and outreach effort, it is possible that not only fewer people will sign up, but that people who are insured may also lose their health coverage by failing to renew, Garfield said. And while some private sector funding may fill in the gap in advertising and outreach, it will be nowhere near sufficient in making up funding from the federal government. Some states with their own marketplaces may try to pick up the slack, but many are also struggling with budget cuts, she noted.
Sharon Long, PhD, senior fellow in the Health Policy Center at the Urban Institute, also said she predicts a “very tough enrollment period” as a result of the barriers to informing people about their options and less time to actually sign up for health insurance coverage.
“It’s going to be tough to maintain the level of coverage we have without the government playing its role in supporting the Affordable Care Act,” Long told The Nation’s Health.
The cuts to advertising and assistance present a particularly detrimental blow to young people, experts say. Hemlin noted that many young adults are new to the health insurance marketplace, with many having recently aged off Medicaid or the Children’s Health Insurance Program. In addition, younger people are the least likely age group to be aware of the marketplace or subsidies for health insurance coverage.
“The fact that so many young adults as well as people in other age groups are unaware of (the marketplace) really does underscore the poor timing of cutting back on advertising by the federal government this year,” Collins said. “Awareness is not high enough to start withdrawing that funding.”
While young people’s participation is especially sought after, it behooves Americans from all backgrounds who do not receive employer-sponsored health insurance to enroll in the federal marketplace.
“It’s worth noting that Americans at all income levels, all races (and all) ethnic groups have benefited from the ACA, and those benefits are at risk if we don’t fully support the ACA or make other changes to improve the health care system,” Long said.
To read the Census Bureau reports, visit www.census.gov.
- Copyright The Nation’s Health, American Public Health Association
