Skip to main content
off the charts

As Job-Based Health Coverage Weakens, Public Coverage Helps Fill the Gap

As we’ve noted, Census Bureau figures released last week show that public programs like unemployment insurance kept millions of people out of poverty in 2010.  They also show that public health programs like Medicaid kept millions of people from becoming uninsured in 2010, as they expanded to help offset the continuing decline in job-based coverage.

Employer coverage has been eroding for a number of years, and this trend accelerated sharply in 2009 and 2010, due in part to steep job losses.  Only 58.6 percent of non-elderly people had employer coverage in 2010, down from 67.7 percent in 2001.

But over the same 2001-2010 period, Medicaid coverage rose significantly, from 11.0 percent of non-elderly people to 16.9 percent, and other forms of public coverage rose as well.  Otherwise, the share of the population with insurance would have fallen even more than it did (see graph).

Among children, the increase in public coverage (through Medicaid and the Children’s Health Insurance Program, or CHIP) over the past decade more than offset the decline in private coverage, so the total number of uninsured children went down.  Among non-elderly adults, the increase in public coverage wasn’t enough to offset the decline in private coverage, mostly because states’ Medicaid eligibility rules are far more restrictive for non-elderly adults than for children.

Working parents are eligible for Medicaid only up to 64 percent of the poverty line in the typical state, unemployed parents are typically eligible only up to 38 percent of the poverty line, and, in most states, childless adults aren’t covered by Medicaid at all.

These data show why it’s so important to implement the Affordable Care Act reforms scheduled to take effect in 2014, which are designed to make coverage available and affordable to people who don’t have employer-based insurance.  Full implementation of the Affordable Care Act will strengthen and extend coverage to most of the 41.8 million adults age 18-64 who lacked insurance in 2010.  It also will prevent insurance companies from denying coverage or charging people with medical conditions very high premiums that they often can’t afford.