May 24, 2018

After a wild year for health policy, what happened to the uninsured rate?

Daily Briefing

    The U.S. uninsured rate remained largely steady for a third consecutive year, increasing slightly from 9% in 2016 to 9.1% in 2017—but coverage gaps between Medicaid expansion and non-expansion states worsened, according to a report released Tuesday by CDC's National Center for Health Statistics (NCHS).

    Upcoming webconference: How to succeed under Medicaid risk

    According to the New York Times' "The Upshot," reports from other organizations, such as Gallup and The Commonwealth Fund, have found that the U.S. uninsured rate increased in 2017, but their findings are based on smaller sample sizes than the one used by CDC.

    CDC report findings

    For the report, CDC researchers estimated health insurance coverage rates among noninstitutionalized U.S. residents in 18 states based on data from the 2017 National Health Interview Survey, which included responses from 78,074 U.S. residents.

    Overall, the researchers found that 29.3 million U.S. residents did not have health insurance in 2017, up slightly from 28.6 million U.S. residents who were uninsured in 2016. According to the researchers, U.S. adults ages 18 to 64 accounted for a majority of those who were uninsured, totaling 25.2 million in 2017—up from 24.5 million in 2016.

    In total, the researchers estimated that 19.3 million fewer U.S. residents were uninsured in 2017 when compared with in 2010—the year the Affordable Care Act (ACA) was enacted. According to the researchers, 17.3 million fewer U.S. adults ages 18 to 64 were uninsured in 2017 when compared with 2010.

    The researchers found that 19.3% of U.S. adults ages 18 to 64 were enrolled in public health coverage in 2017, while 69.3% were enrolled in private health plans, including 4.3% who were enrolled in exchange plans—a figure largely unchanged from the previous year, "Vitals" reports.

    Adults in Medicaid expansion states less likely to be uninsured

    The researchers found that insured rates among U.S. adults ages 18 to 64 who lived in states that expanded Medicaid under the ACA increased from 2016 to 2017, while insured rates among U.S. adults ages 18 to 64 who lived in states that had not expanded Medicaid decreased.

    In particular, the researchers found that the share of uninsured adults ages 18 to 64 in Medicaid expansion states decreased slightly from 9.2% in 2016 to 9.1% in 2017. In comparison, the share of uninsured adults ages 18 to 64 in non-expansion states increased from 17.9% in 2016 to 19% in 2017.

    According to the researchers, uninsured rates among U.S. adults ages 18 to 64 increased in several states, including:

    • Georgia, which has not expanded Medicaid, where the uninsured rate increased from 18.4% in 2016 to 20.3% in 2017;
    • Illinois, which has expanded Medicaid, where the uninsured rate increased from 8.2% in 2016 to 10.5% in 2017;
    • North Carolina, which had not expanded Medicaid, where the uninsured rate increased from 15% in 2016 to 17.7% in 2017; and
    • Texas, which has not expanded Medicaid, where the uninsured rate increased from 24.7% to 26.4%.

    The researchers also found that uninsured rates among U.S. adults ages 18 to 64 dropped in some states, including:

    • Michigan, which has expanded Medicaid, where the uninsured rate declined from 9.5% in 2016 to 8.1% in 2017;
    • Pennsylvania, which has expanded Medicaid, where the uninsured rate dropped from 8.3% in 2016 to 7.3% in 2017; and
    • Washington, which has expanded Medicaid, where the uninsured rate dropped from 8.2% in 2016 to 7.5% in 2017.

    Uninsured rate could rise

    According to Axios' "Vitals," the CDC report does not show the "full effects" of policy shifts related to health insurance that have been implemented or proposed under the Trump administration, because many of the changes have not yet taken effect. For instance, the administration has called for the expansion of short-term health plans, and Republicans have eliminated the ACA's individual mandate beginning in 2019—both of which could affect exchange plan enrollment, "Vitals" reports.

    According to "The Upshot," rising premiums for individual health plans and work requirements for Medicaid also might cause the U.S. uninsured rate to increase over the next few years (Baker, "Vitals," Axios, 5/22; Sanger-Katz, "The Upshot," New York Times, 5/22; Frieden, MedPage Today, 5/22; Diamond, "Pulse," Politico, 5/22; CDC report, 5/22).

    Upcoming webconference: How to succeed under Medicaid risk

    The Medicaid population presents a challenge for many health care providers. Low reimbursement rates coupled with high patient complexity are responsible for margin pressure. Join our virtual panel discussion with Advisory Board experts to inform a sustainable Medicaid strategy.

    Register Here

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