On September 12, the Census Bureau will release estimates of the number of Americans with and without health insurance coverage in 2011, based on its annual Current Population Survey. Other survey data and historical trends provide clues as to what the Census data are likely to show.
Preliminary data from the Centers for Disease Control and Prevention (CDC) indicate that in 2011, the number of uninsured Americans fell for the first time in four years. These data further suggest that federal policies were responsible for the gains in coverage. The largest increase in coverage, according to the CDC data, occurred among young adults, a group benefiting from an Affordable Care Act (ACA) provision allowing adult children up to age 26 to stay on their parents’ private insurance plans. Children’s coverage also held steady, due to continued enrollment gains in Medicaid and the Children’s Health Insurance Program (CHIP), which were bolstered by a federal requirement that states maintain their eligibility rules and procedures for Medicaid and CHIP. In contrast, private health coverage among adults between 26 and 64 years old — a group for whom the major ACA coverage expansions are not yet in effect— continued to decline, marking the fourth consecutive year of a decline in the coverage rate for this group.
MORE RE INSURED, BUT NOT AT PRE-RECESSION LEVELS
In June, the CDC released early estimates from its National Health Interview Survey (NHIS), a nationally representative sample that tends to track well with the more widely known Census Bureau data from the Current Population Survey (CPS). NHIS data indicate that the number of Americans without health insurance coverage declined in 2011 by 2.3 million people to 46.3 million uninsured Americans (see Figure 1).
The share of all people without health insurance coverage also dropped — by nearly 1 percentage point, from 16.0 percent in 2010 to 15.1 percent in 2011. This is the largest decline in a single year in the percentage of people without insurance since CDC began collecting these data in 1997. It reverses a three-year trend in the NHIS data from 2008 through 2010 in which both the number of uninsured Americans and the percentage of people without insurance increased each year.
The CDC data also show, however, that despite the improved coverage numbers, coverage levels remain below the levels prior to the Great Recession. In 2011, 3.2 million more Americans were uninsured than in 2007. The percentage of people without coverage also remains higher than in 2007, when 14.5 percent of the population was uninsured.
YOUNG ADULTS BENEFIT FROM HEALTH CARE LAW
According to the NHIS data, more Americans had health insurance in 2011, due primarily to a substantial increase in the share of young adults with private coverage. Among adults aged 19 through 25, some 56.2 percent had private insurance coverage in 2011 — 5.2 percentage points more than in 2010. Similarly, the percentage of adults aged 19-25 who lack insurance declined, by a full 6 percentage points — from 33.9 percent in 2010 to 27.9 percent in 2011 — as a result of the large increase in private coverage, as well as modest growth in public coverage enrollment in programs such as Medicaid and CHIP.
A provision of the ACA is likely the overwhelming contributor to the increased private health insurance coverage among young adults. Under the ACA, adult children can now obtain coverage through their parents’ health insurance plans up to their 26th birthday. This provision marks an important shift from prior rules, under which young adults typically no longer could be covered by their parents’ health plans once they turned 19 or graduated from college. This provision first took effect in September 2010, meaning that 2011 represented the first full year that the provision affected health insurance coverage rates. For a measure of that impact, consider that the share of people with private coverage increased by the aforementioned 5.2 percentage points among the young adults targeted by the ACA provision even as it decreased by 0.7 percentage points among those aged 26 through 35.