Rising Rates of Uninsured Americans Threaten Health Outcomes

Changes in the prevalence of health insurance coverage and the distribution of coverage types are closely tied to shifts in economic trends, demographic composition and policy changes affecting access to care. Within the United States, a lack of health insurance coverage has been a persistent problem, despite the introduction of the Affordable Care Act (ACA) in 2010. Although these policy changes led to the growth of the share of insured Americans, current trends reveal that coverage is yet again on the decline.

Recently released by the Census Bureau, the 2018 Health Insurance Coverage in the United States report presents the state of health insurance coverage in the United States in 2018, revealing worrying changes in insurance trends between 2017 and 2018.

Decline in Number of Insured Individuals

According to the latest data from the Census Bureau, the percentage of Americans without health insurance rose for the first time in nearly a decade. In 2018, the rate of individuals without coverage increased to 8.5% – up 0.5% from the previous year – which is the equivalent of 27.5 million uninsured Americans. Overall, the percentage of people with health insurance coverage for all or part of 2018 in the United States was 91.5%, compared with 92.1% in 2017. The decline was also evidenced in the number of insured children – which dropped by 425,000.

Who Are the Uninsured?

Most members of the uninsured population come from low-income families, with at least one worker in the family, and tend to live in states with limited access to Medicaid. In 2018, 45% of uninsured non-elderly adults remained uninsured due to the high cost of health care coverage. Many members of the uninsured population do not have access to insurance through their employment, while others remain ineligible for financial assistance for coverage.

The growing uninsured, low-income population faces not only a lack of access to health care, but also unaffordable medical bills, which translate to medical debt. In 2018, uninsured non-elderly adults were twice as likely as their insured counterparts to have issues paying their medical bills.

The latest data also reports a significant increase in the share of Hispanic individuals without health insurance coverage, which grew to 8.7% from the prior year – the most significant change in any racial group. People of color faced a higher risk of being uninsured than their non-Hispanic white counterparts; while they make up 43% of the total non-elderly U.S. population, people of color account for over half of all non-elderly uninsured Americans, according to data from the Kaiser Family Foundation.

Furthermore, the report reveals a drop in the rate of children with health insurance coverage. More children were uninsured in 2018 than in the prior year; approximately 4.3 million children were uninsured last year – up from 425,000 in 2017. The decline in the share of lower-income children covered by Medicaid or the Children’s Health Insurance Program is in part due to the decreasing accessibility of these programs and rising costs of health insurance coverage.

Private Health Insurance Remains Steady

In 2018, private health insurance continued to be more prevalent than public health coverage and covered over 67% of the population. Employer-based insurance remains the most common form of private health insurance, covering 55.1% of the population. While the percentage of individuals with private health coverage did not statistically change within the past year, there was a notable decline in the number of people covered by Medicaid as the program becomes less accessible due to policy changes. However, the share of individuals covered by Medicare increased between 2017 and 2018 as a result of the growing aged population.

The recent trends revealed in the latest Census Bureau report show that the insurance coverage gains afforded by the Affordable Care Act are receding. Despite nationwide declines in poverty and unemployment rates, this is the first increase in the number of Americans without health insurance coverage to occur since 2009 and since the ACA was passed in 2010. While a variety of proposed public policy solutions are currently being contested, an increase in uninsured individuals threatens improvements in access to care as well as overall population health outcomes and requires urgent repair.