Today’s Census Bureau report shows that the number and share of Americans without health insurance rose by 4.3 million and 1.3 percentage points, respectively — the largest single-year increases on record on data that begin in 1999.
The increases were driven by a decline in private health coverage resulting from large reductions in employer-based coverage, which have been occurring for a number of years but accelerated sharply in 2009. Just 58.9percent of the non-elderly population had employer coverage in 2009, compared to 67.8 percent in 1999.
Only a significant growth in Medicaid coverage (and other smaller government-funded or subsidized health care programs) prevented a much larger increase in the number of uninsured, as the graph shows. The percentage of non-elderly Americans with coverage through Medicaid rose from 14.9 percent in 2008 to 16.6percent in 2009.
While the share of working-age adults lacking coverage went up, the share of children lacking coverage didn’t, thanks to a large increase in the number of children covered through Medicaid and the Children’s Health Insurance Program. The different outcomes for children and adults illustrate the importance of health reform, which will give adults much of the improved access to affordable coverage through both private and public health care programs that children already enjoy.
The Affordable Care Act will expand Medicaid eligibility to cover low-income adults with incomes up to 133 percent of the poverty line (roughly $29,000 for a family of four in 2010), starting in 2014.
The law also calls for the creation of health insurance “exchanges” in all states to give individuals and small businesses a choice of affordable private health plans. People who can’t get affordable coverage through their employer and have incomes too high to qualify for Medicaid and the Children’s Health Insurance Program (but below 400 percent of the poverty line) will qualify for tax credits to help them afford coverage in the exchanges.
The Congressional Budget Office estimates that by 2019, these provisions will enable 32 million otherwise-uninsured Americans to obtain health coverage. Had these provisions been in effect in 2009, the increase in the number of uninsured Americans would unquestionably have been much smaller.