Ninety-two percent of adults were insured in 2023, according to new data from the U.S. Census Bureau. Most children had health insurance coverage as well, though the number without it grew.
Photo by Triloks, courtesy iStockphoto
“It’s instructive, because we saw that there are ways to reduce poverty. It’s pretty clear evidence that the poverty rate, especially for children and families, is something we have tools to change.”
— Jacob Hibel
The majority of Americans had health insurance in 2023. Yet despite long-term gains, the rate of children who lacked coverage crept up, according to new data from the U.S. Census Bureau.
Ninety-two percent of U.S. adults were insured in 2023, according to “Health Insurance Coverage in the United States: 2023,” one in a series of bureau reports released in September. The rate of adults who lacked insurance held steady at about 8% —approximately 26.4 million people.
The uninsured rate for children rose, however, jumping from 5.4% in 2022 to 5.8%, with about 4.4 million children lacking coverage in 2023. Coverage fell for children of all races and ethnicities, but dropped the most among Hispanic children, 9.4% of whom lacked insurance last year. About 4.8% of Black children were uninsured, as were 4.4% of white children and 4.2% of Asian children.
Kids in states that had not expanded Medicaid eligibility were uninsured at about twice the rate of those that had expanded.
A decrease in employer-sponsored coverage among adults may have contributed to the higher uninsured rate in kids. The 2023 “unwinding” of pandemic emergency protections that kept families continuously enrolled in Medicaid and the Children’s Health Insurance Program may also have played a role, according to Katherine Hempstead, PhD, senior policy adviser for the Robert Wood Johnson Foundation.
“We do have a pretty good eligibility system for kids, so there’s really no reason to see kids’ uninsurance rates going up,” Hempstead told The Nation’s Health. “Depending what the tail of the unwinding process looks like, that might be something that continues to drag down kids’ coverage numbers.”
For adults, an increase in signups for marketplace plans under the Affordable Care Act and the use of tax credits to lower health plan premiums played a role in keeping their coverage rate steady, she said.
“It reflects relative stability in Medicaid and also the growth of the marketplace,” Hempstead said. “Enrollment has increased in the last couple years in the individual market and that’s reflected in the breakouts by coverage type.”
Most Americans who were insured in 2023 had private insurance, which includes direct-purchase coverage, such as ACA marketplace plans, and employer-sponsored plans, which made up more than half of all private coverage. The remaining 36% of insured Americans had public insurance, including Medicaid, Medicare or coverage from Department of Veterans Affairs programs. Direct-purchase coverage and Medicare each rose by 0.2% from 2022 to 2023, while employer-sponsored coverage fell 0.7%.
The rate of uninsured Americans living in states that had expanded Medicaid coverage was 6.4%, versus 11.3% in states that had not expanded Medicaid. Texas, which has not expanded Medicaid, had the highest rate of uninsurance at 16.4%, while Massachusetts had the lowest rate at 2.6%
Uninsured rates for working age adults fell from 12.9% to 11%, dropping in 42 states over four years, according to “State Health Insurance Coverage: 2013, 2019 and 2023,” another Census Bureau report released in September.
Hispanic adults remained the most likely to be uninsured. With little shift from 2022, almost a quarter of Hispanic adults ages 19 to 64 lacked coverage, followed by 11% of Black, 7% of white and 6.8% of Asian adults.
Poverty increases under one measure
The new census data also detailed poverty in America. At nearly 37 million people, the number of people living in poverty was not statistically different from 2022 to 2023, according to the bureau’s “Poverty in the United States: 2023” report. But poverty measurements told two different stories.
The bureau uses an official poverty measure that looks at a family’s cash income, and a supplemental poverty measure that looks at cash income plus tax credits, household expenses, benefits such as the Supplemental Nutrition Assistance Program and more.
Overall, poverty fell to 11.1% from 2022 to 2023 under the official measure, but increased to 12.9% using the supplemental poverty measure. Under the official measure, the child poverty rate was 15.3%, a negligible 0.3% increase since 2022, compared with the supplemental measure rate of 13.7%, which rose by a more significant 1.3%.
The official and supplemental measures also differed on poverty rates for working-age adults — at 10% versus 12.2%, respectively — and people ages 65 and older — at 9.7% versus 14.2%, respectively.
Under the supplemental poverty measure, there were also statistically significant increases in poverty for Hispanic and Asian people. Poverty declined for American Indian and Alaska Native people under both poverty measures.
The supplemental poverty measure does a better job at capturing real-life experiences of people in poverty, according to Jacob Hibel, PhD, MA, an associate professor of sociology at the University of California-Davis and co-director of the school’s Center for Poverty and Inequality Research. It is traditionally higher than the official rate, but differed for the first time during the emergency phase of the COVID-19 pandemic as families received financial assistance such as tax credits and stimulus payments, Hibel added.
“It’s instructive, because we saw that there are ways to reduce poverty,” Hibel told The Nation’s Health. “It’s pretty clear evidence that the poverty rate, especially for children and families, is something we have tools to change.”
By state, New Hampshire had the lowest rate of poverty at 7.2%, while Mississippi and Louisiana had the highest at 18% and 18.9%, respectively, according to the bureau’s “Poverty in States and Metropolitan Areas: 2023” report. Though Mississippi had one of the highest poverty rates, it was among seven states where poverty decreased, joining Arkansas, Florida, Kansas, Missouri, North Dakota and West Virginia. Meanwhile, poverty increased in Georgia, Tennessee and Utah.
Income increases, inequality persists
The median U.S. household income increased 4% from $77,540 in 2022 to $80,610 in 2023, the most statistically meaningful increase since 2019, according to the bureau’s “Income in the United States: 2023” report. The number of total workers went up 1.3 percent, or 2.2 million, in the same time period.
“Beating inflation by 4% is pretty significant for that one-year change,” Elise Gould, PhD, MPAff, senior economist for the Economic Policy Institute, told The Nation’s Health. “The reason why we saw those increases was because we had a much better labor market. So many people depend on work for most of their income. The fact that there were so many more jobs created...and wage growth was stronger, I think those are sort of the reasons that led to that.”
Income disparities persisted in 2023, however. The only workers with higher incomes in 2023 versus 2022 were white households, increasing 5.7% to $89,050. Incomes for Hispanic, Black and Asian households — at $65,540, $56,490 and $112,800, respectively — were not statistically different from 2022, according to the bureau.
Rising housing costs amplified income disparities. Nearly half of the country’s 42.5 million renters spend more than 30% of their income on rent, according to the 2023 American Community Survey. More than half of the 4.6 million Black renters, 56.2%, spend more than 30% of income on rent, compared with 46.7% of 10.4 million white renters. Over half of the 4.8 million Hispanic renters have the same cost burden.
“Costs of living are increasing, and these gains in income are only being enjoyed by some segments of the population,” Hibel said. “It’s a sort of forecast of increased inequality along the lines that have historically defined opportunities in the U.S. It doesn’t seem to be foretelling increases in opportunities for members of historically marginalized or underserved populations.”
For more information on the new U.S. Census Bureau reports, visit www.census.gov.
- Copyright The Nation’s Health, American Public Health Association
