Uninsured Numbers in U.S. Dropped by 8.8M in 2014, Census Says

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By Sara Hansard

Sept. 16 — The portion of the U.S. population without health insurance declined by 2.9 percentage points to 10.4 percent in 2014, a reduction of 8.8 million people from 2013, the Census Bureau reported Sept. 16.

“After several years of a relatively stable uninsured rate between 2008 and 2013 as measured by the American Community Survey, the percentage of the population who were uninsured at the time of the interview dropped in 2014,” Victoria Velkoff, chief of the Census Bureau's Social, Economic, and Housing Statistics Division, said in a telephone press conference.

The percentage of people with health insurance for all or part of 2014 was 89.6 percent, up from 86.7 percent in 2013, according to a Census release. The rate of uninsured declined despite the fact that there was no change from 2013 to 2014 in either median household income or the official poverty rate. Velkoff said the rate of uninsured dropped as primary provisions of the Affordable Care Act providing coverage began to take effect in 2014.

Beginning in 2014 the Census Bureau implemented a redesigned health insurance survey to measure coverage in 2013, which the agency said corrected past problems with its health insurance data and established a strong baseline to compare health insurance coverage between 2013 and 2014, when the ACA health insurance marketplaces began operating and the law's primary health insurance changes took effect, including prohibitions against refusing coverage or charging more to people with medical problems and the provision of financial subsidies for moderate- and low-income people to buy coverage.

Private, Medicaid Coverage Increased Most

Between 2013 and 2014 the greatest changes in coverage rates were increases in private health insurance purchased directly from insurers or through the ACA exchanges and increases in Medicaid, the Census Bureau said. Private coverage increased by 1.8 percent point to 66 percent in 2014, covering 208.6 million people. Some 55.4 percent—or about 175 million people—had employment-based coverage in 2014, a statistically insignificant change from the 55.7 percent who had employer coverage in 2013. Direct purchase private coverage increased from 11.4 percent in 2013 to 14.6 percent in 2014, when it covered 46.2 million people.

The share of people with government plans rose from 34.6 percent in 2013 to 36.5 percent in 2014, when about 115.5 million people had government coverage. Medicare coverage rose from 15.6 percent in 2013 to 16 percent in 2014, when it covered more than 50.5 million people. Medicaid coverage, which was expanded under the ACA in states that chose to adopt the new program, increased from 17.5 percent of the population in 2013 to 19.5 percent in 2014, when it covered about 61.7 million people.

Between 2013 and 2014 decreases in the uninsured rate were generally greater in states that expanded Medicaid under the ACA than in non-expansion states, the Census Bureau reported. The decrease in the uninsured rate was 3.4 percentage points in expansion states compared with 2.3 percentage points in non-expansion states. In expansion states the uninsured rate was 9.8 percent, compared with 13.5 percent in non-expansion states.

In 2014 the state with the lowest percentage of people without health insurance was Massachusetts at 3.3 percent, while the highest uninsured rate was for Texas at 19.1 percent.

Rate Drops Most for Working-Age Adults

While the uninsured rate dropped for people of all ages under 65 between 2013 and 2014, the largest decreases occurred among working-age adults ages 19 to 64. In 2014 the highest uninsured rate was 25.1 percent at age 26. The ACA requires plans that offer dependent coverage to make the coverage available until the adult child reaches 26.

Uninsured rates dropped for all income categories, but more for people with lower income, the Census Bureau said. In 2014, 16.6 percent of people in households with annual income of less than $25,000 had no health insurance, compared with 5.3 percent in households with income of $100,000 or more. In 2013, 20.9 percent of the lower-income group was uninsured, along with 6.1 percent of the higher-income group.

The uninsured rate dropped for all race and ethnic groups between 2013 and 2014. The uninsured rate for Hispanics in 2014 was 19.9 percent; for blacks and Asians, 11.8 percent and 9.3 percent, respectively; and for non-Hispanic whites, 7.6 percent. The decrease for blacks, Asians and Hispanics was just over 4 percentage points, and for non-Hispanic whites, 2.1 percentage points.

The White House made note of the gains in coverage. “The share of people without health insurance coverage declined in every single state in the country in 2014—for the first time in the history of the [Census Bureau] series—as the Affordable Care Act’s major coverage provisions took effect,” Jason Furman, chairman of the Council of Economics Advisers (CEA), CEA member Sandra Black and CEA chief economist Matt Fiedler, said in a blog posting.

The Census Bureau's findings are “dramatic proof that the Affordable Care Act is a stunning success,” Ron Pollack, executive director of Families USA, which supports the ACA, said in a release. “The historic decrease in the number of uninsured Americans is unmistakably attributable to the Affordable Care Act's implementation.”

To contact the reporter on this story: Sara Hansard in Washington at shansard@bna.com

To contact the editor responsible for this story: Janey Cohen at jcohen@bna.com