May 17, 2017

For the first time since ACA passed, U.S. uninsured rate doesn't drop, CDC says

Daily Briefing

    The number of uninsured U.S. residents remained mostly unchanged from 2015 to 2016, marking the first time since the Affordable Care Act (ACA) passed in 2010 that the uninsured population did not significantly decrease from one year to the next, according to a report released Tuesday by CDC's National Center for Health Statistics (NCHS).

    Help your newly insured patients escape the patient access maze

    For the report, NCHS estimated 2016 health insurance coverage rates in 45 selected states based on data from CDC's 2016 National Health Interview Survey. The survey included responses from 97,459 people.

    Findings

    NCHS estimated that about 28.6 million U.S. residents were uninsured in both 2015 and 2016, down from about 48 million who were uninsured in 2010. The U.S. uninsured rate between 2015 and 2016 also remained mostly level, decreasing from 9.1 percent of the total U.S. population in 2015 to 9 percent in 2016.

    Among U.S. adults ages 18 to 64, NCHS estimated that:

    • 69.2 percent were enrolled in private health coverage;
    • 20 percent were enrolled in public health coverage.

    According to the report, coverage gains have been most prominent among U.S. adults ages 18 to 64. The uninsured rate for that age group fell from 20.4 percent in 2013 to 12.4 percent in 2016.

    NCHS estimated that certain groups were more likely to be uninsured than others. For example, U.S. adults ages 25 to 34 were about twice as likely as adults ages 45 to 64 to lack health coverage. NCHS estimated that the uninsured rate in 2016 was:

    • 16.5 percent among adults ages 25 to 34;
    • 14.4 percent among adults ages 35 to 44;
    • 13.7 percent among adults ages 18 to 24; and
    • 8.9 percent among adults ages 45 to 64.

    Further, NCHS estimated that the percentage of uninsured U.S. children decreased from 13.9 percent in 1997 to 5.1 percent in 2016. Among U.S. residents ages 0 to 17 who had coverage in 2016, NCHS estimated that:

    • 53.8 percent were enrolled in private coverage; and
    • 43 percent were enrolled in public coverage.

    ACA coverage expansions

    According to the report, adults living in states that expanded Medicaid under the ACA were less likely to be uninsured than those residing in non-expansion states. In Medicaid expansion states, 9.2 percent of adults lacked health coverage in 2016, compared with 17.9 percent in non-expansion states.

    Further, CDC found that adults living in states that rely on the federal exchange for enrollment in ACA exchange plans were more likely to be uninsured than adults residing in states that operated their own exchanges or operated an exchange in partnership with the federal government.

    Still, NCHS estimated that the percentage of U.S. residents under age 65 who in 2016 were enrolled in health plans sold through the exchanges increased significantly from 2015 to 2016, growing from about 9.1 million during the last three months of 2015 to about 11.6 million during the last three months of 2016.

    Comments

    Health economist Gail Wilensky, who has criticized the ACA, called the stall in the U.S. uninsured rate's decline "disappointing," but added that "the real question is, will we be able to keep the gains that we have made?"

    Katherine Hempstead, director of health insurance research at the Robert Wood Johnson Foundation, said, "It looks like we are kind of sticking a landing and holding onto the [coverage] gains." She added, "To increase coverage, you would have to see more states take up the Medicaid expansion, and some reforms to increase take-up in the individual (private) market."

    Both Wilensky and Hempstead said the U.S. uninsured rate could start rising again, particularly in response to Republican efforts to repeal and replace the ACA. "This release is really timely because it just helps everybody focus on what's at stake," Hempstead said (Alonso-Zaldivar, AP/Sacramento Bee, 5/16; Nather, "Vitals," Axios, 5/16; CDC National Center for Health Statistics report, May 2017).

    How will states utilize waivers to reform Medicaid? Join us on May 22 to find out.

    At the same time many states are considering Medicaid reforms, new HHS Secretary Tom Price has signaled the administration’s intent to expand use of waiver authority to grant states flexibility. States use these waivers to modify both coverage and care delivery requirements in Medicaid, potentially impacting provider strategy, finances, and operations.

    This webconference provides an overview of waivers that are available, the Medicaid reform goals that states often pursue, and the evolution of reform models over time. We also highlight case studies of several states that have already used waivers to align their Medicaid programs with local priorities.

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