Uninsured Rate Fell or Held Steady in Almost Every State Last Year, New Census Data Show

The share of residents without health coverage fell in 20 states last year, Census data released yesterday show, while rising in just one.  This improvement largely reflect increased private coverage among young adults — helped by a health reform provision allowing them to stay on their parents’ insurance plans until age 26 — and greater enrollment in public programs such as Medicaid and the Children’s Health Insurance Program (CHIP). 

These findings are consistent with last week’s Census data from the Current Population Survey (CPS), which indicated that the number of uninsured Americans fell by 1.3 million in 2011 and the share of Americans without health insurance fell from 16.3 percent to 15.7 percent, the largest single-year drop since 1999.^[1]   Yesterday’s data come from a different Census Bureau survey — the American Community Survey (ACS) — that allow for more detailed analysis of health insurance coverage changes at the state level than the CPS data, which have inadequate sample sizes in some states. 

The ACS data show that a substantial number of states made progress in reducing the number of people without health insurance coverage.

• In 18 states, the number of residents without health insurance coverage fell.  As noted, the percentage of the population without health insurance coverage fell in 20 states.
• In 34 states, the percentage of 18- to 24-year-olds with private coverage increased; the number of residents in this age group with private coverage increased in 35 states.
• In 34 states, the number of residents enrolled in Medicaid increased.

For states that did not see a reduction in the uninsured rate, it appears that the gains in private coverage among young adults and/or the increases in public program enrollment were only able to offset — rather than more than offset — the continued overall erosion of employer-sponsored insurance.  In Missouri, the only state whose uninsured rate rose in 2011, the gain in private coverage among young adults was not enough to offset the decline in private coverage among adults aged 25 to 64 while Medicaid and CHIP enrollment remained steady.

Uninsured Rate Fell in 20 States, Due to Health Reform and Public Programs

The ACS data are consistent with the earlier Census data from the CPS.  (Under the ACS data, the number of uninsured Americans decreased by roughly 830,000 and the percentage without health insurance coverage fell from 15.5 percent in 2010 to 15.1 percent in 2011.)  The ACS data also show that the reduction in 2011 in the share of people without insurance coverage occurred across a diverse set of states.  The uninsured rate declined significantly in 20 states and remained flat in 30 states.  (Tables 1 and 2 show the changes in the percentage and number, respectively, of uninsured individuals and children under 18 in each state.)

The state-level ACS data confirm that a key contributor to these coverage gains was a substantial rise in health coverage among young adults, which largely reflected a health reform provision enabling adult children to get coverage through their parents’ health insurance plans until their 26th birthday.  This provision marked a significant shift from prior rules, under which young adults typically were no longer eligible for their parents’ health plans once they turned 19 or graduated from college. 

The young adult provision took effect in September 2010, so 2011 represented the first full year that it affected health insurance coverage rates.  In 34 states, the rate of private coverage among young adults aged 18 to 24 increased; at the same time, the rate of private coverage among adults aged 25 to 64 fell in most states. 

In 21 states, the increase in private coverage among young adults entirely offset the continuing erosion in private coverage among other non-elderly adults.   Table 3 shows the change between 2010 and 2011 in private coverage rates in each state for young adults, adults aged 25 to 64, and all non-elderly adults (aged 18 to 64).

The ACS data also show that enrollment increases in public programs, particularly Medicaid and CHIP, contributed to the coverage gains across the states.  Federal policies, including a temporary increase in Medicaid funding for states through June 2011 (which policymakers included in the 2009 Recovery Act and later extended) and health reform’s requirement that states maintain their Medicaid and CHIP eligibility levels and enrollment procedures, likely enabled these programs to cover more low-income people during the slow economic recovery.  Medicaid and CHIP enrollment tends to continue rising for a few years after the end of a recession.  Table 4 shows the change in the Medicaid coverage rate in each state for all individuals and children under 18. 

States will have an opportunity to make substantially greater progress in covering uninsured low-income adults starting in 2014, when the health reform provisions enabling them to extend Medicaid to nearly all individuals up to 133 percent of the poverty line take effect.  The recent Supreme Court decision gives states the choice of whether or not to institute that expansion.   Some 30 million people who would otherwise be uninsured will gain coverage under health reform by 2022, the Congressional Budget Office estimates, with 11 million people gaining Medicaid coverage.  The gains in insurance coverage will be even greater if all or nearly all states adopt the Medicaid expansion.