High deductible plan use jumps since 2010, now at 43%
The National Center for Health Statistics’ latest report on health insurance found that 9% of all ages surveyed between January and September last year were uninsured. That’s “not significantly different” from the previous year.
Drilling down into those numbers, 12.7% of adults between 18 and 64 were uninsured, 19.5% had public coverage and 69.3% had private health insurance.
High-deductible health plans (HDHPs) inched closer to half of people under 65 who are insured by a private health insurance plan. The survey found that 43.2% of those individuals had an HDHP, which was an increase from 39.4% the previous year.
One of the largest trends in the report involved HDHPs. Enrollment in those plans has increased nearly 18 percentage points since 2010 and did so again in the last year studied. Employers and payers have increasingly turned to HDHPs as a way to give consumers more “skin in the game.” The belief goes that putting more costs on individuals will result in making them better healthcare consumers.
Evidence hasn't borne that out, however. A critical piece of the theory is providing easily digestible information on cost and quality to let patients make better healthcare decisions. That largely hasn’t happened despite patients shouldering more of the healthcare costs. Efforts by payers and providers haven’t increased patient healthcare literacy and patients still have a difficult time finding the cost and quality data.
Overall, the percentage of uninsured stayed at 9% compared to 2016. This is somewhat surprising given the Trump administration’s opposition to the Affordable Care Act and Republican promises to repeal and replace the law. That didn't ultimately happen, with the exception of repeal of the individual mandate penalty in tax legislation at the end of the year, though that was before the latest survey took place.
ACA open enrollment for 2018 did drop from 2017 numbers, but not as much as predicted, given the enrollment period was cut in half and the advertising budget was slashed by 90%.
The survey highlights changes across individual state rates.
Texas’ uninsured rate for adults aged 18-64 increased from 24.7% to 26.3%. Georgia increased from 18.4% to 20.9% and North Carolina ticked up from 15% to 16.8%. However, some states saw lower rates of uninsured, including Florida (19.8% to 19.5%) and Michigan (9.5% to 7.8%).
The poorest Americans remain more likely to not have health insurance. The report found 24.2% of people classified as poor and 23.4% of people classified as near poor did not have health insurance. That’s compared to 8.1% of people who were not poor. Poor and near poor people saw the largest decreases in uninsured rates since 2013, but none of the economic groups have seen a significant change in the percent of uninsured over the past three years.
The recent survey showed 27.2% of Hispanics, 13.6% of non-Hispanic black, 8.4% of non-Hispanic white and 8% of non-Hispanic Asian adults lacked health insurance in 2017. Those numbers didn't change significantly from 2016.
Meanwhile, the number of insured children remains higher than adults. Nearly 5% of children under the age of 18 were uninsured. That’s largely because of public programs like Medicaid and the Children’s Health Insurance Program (CHIP). Nearly 42% of children had health insurance through public program coverage. About 55% were covered by private health insurance.
Not surprisingly, states that expanded Medicaid through the ACA had lower uninsured rates than non-expansion states in 2017. Medicaid expansion states’ uninsured rates decreased from 18.4% in 2013 to 9% in 2017. Non-expansion states were at 22.7% in 2013. That dropped to 17.5% in 2015, but was up to 18.9% in 2017.