- The rate of uninsured Americans stayed essentially stable last year — between 8.6% and 9.7% — as Medicaid and Affordable Care Act marketplace offerings offset losses of employer coverage. But there are still sizable disparities in who lacks health insurance coverage, according to new federal data.
- Between 28 million and 31.6 million people were uninsured in 2020, roughly the same as the about 30 million U.S. residents uninsured in 2019 before the COVID-19 pandemic, according to HHS' Office of the Assistant Secretary for Planning and Evaluation.
- The Biden administration released the numbers just before the start of the open enrollment period in the federal health insurance marketplaces on Monday.
Despite dire predictions during the worst of the pandemic last year that widespread job losses would result in a massive chunk of the population losing coverage, ASPE's new report bolsters more recent research finding the uninsured rate remained relatively unchanged in 2020.
Medicaid and marketplace enrollment played an important role as a safety net preventing rampant coverage losses during a time of great economic and public health volatility, HHS said.
The moderate decline in job-sponsored insurance during the COVID-19 recession (about 2 million to 3 million U.S. residents, depending on the data set) was counterbalanced by the greater than 10 million increase in Medicaid enrollment, as the government paused state redeterminations, and to a lesser extent marketplace growth last year, which saw 2.8 million Americans gain coverage, ASPE said.
In January, Medicaid surpassed Medicare as the nation's largest source of insurance coverage following that sharp spike in enrollment.
However, uninsured rates continue to be higher among traditionally underserved populations, including Latinos (18.3%), Black Americans (10.4%) and people with incomes below the poverty line (17.2%). Uninsured rates are also higher in states that haven't expanded Medicaid (17.6%).
People in those states are nearly twice as likely to be uninsured compared to those living in expansion states, HHS noted. Twelve states have yet to expand the safety-net insurance coverage despite additional financial incentives to do so under the American Rescue Plan passed in March.
Hiking insurance access is a key political priority for Democrats on the Hill, though current congressional divisions are stymieing the party's most far-reaching plans. However, under a budget blueprint released by President Joe Biden on Thursday, uninsured people in non-expansion states could get subsidized private coverage through HealthCare.gov at no additional cost to them.
And Medicaid and ACA enrollment both appear to have continued their momentum in 2021, ASPE said. More recent administrative data shows ongoing gains in Medicaid (1.7 million added to the rolls between January and April this year) and marketplace coverage (1.6 million between August 2020 and August of this year).
That suggests the uninsured rate could be even lower now than estimated, researchers said, chalking the gains partially up to a more substantial special enrollment period in the spring and summer this year, including the implementation of the ARP's expanded subsidies.
The Biden administration launched the open enrollment period for 2022 coverage on the exchanges on Monday, touting the affordability and options of the ACA coverage.
Four out of five people have access to a plan for $10 or less a month due to the ARP's financial assistance, while the average consumer is able to choose between six and seven insurance companies with plan options, HHS said.
And the administration, which has made promoting equity a key prong of its healthcare agenda, also noted it was taking steps to close disparities in coverage.
Along with extending the open enrollment period by an additional 30 days, the administration quadrupled the number of assistants helping consumers navigate the enrollment process and relaunched a program partnering with community organizations to provide outreach and education about the marketplace.