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Analysis

Despite Strong Economy, Uninsured Ranks Grew by 700,000 People

By John Commins  
   August 15, 2019

Population growth and gains in employer-sponsored coverage did not overcome drops in Medicaid, CHIP and ACA marketplace coverage.

Even with a strong economy and robust job market, 700,000 people lost health insurance between 2016 and 2017, an Urban Institute study shows.

The uninsured rate national increased from 10% in 2016 to 10.2% in 2017, the first increase since 2013 and the advent of the Affordable Care Act. Under the ACA, the uninsured rate fell every year between 2013 and 2016 and 18.5 million people gained coverage, according to the study, which was commissioned by the Robert Wood Johnson Foundation.

The report found that population growth and increases in employer-sponsored insurance mitigated, but did not overcome, reductions in Medicaid and CHIP and ACA marketplace coverage.

"An additional 2.3 million people had ESI in 2017, but 1.9 million fewer people had coverage through Medicaid, CHIP, or the ACA marketplaces," the report said.

The uninsured rate in Medicaid expansion states held at 7.6%, but grew from 13.7% to 14.3% in non-expansion states, which also lost marketplace coverage at twice the rate of expansion states.

The coverage losses were felt across all age groups and incomes, although non-Hispanic white and black nonelderly people, those with at least some college education, and people living in the South and Midwest saw disproportionate coverage losses.   

Earlier this week, the Centers for Medicare & Medicaid Services reported that enrollment in the individual health insurance market continued to decline last year, especially among those who pay full price for their coverage.

After average monthly enrollment in the individual market rose 7% from 2015 to 2016, it fell 10% in 2017 and another 7% in 2018, according to the CMS report.

Unsubsidized beneficiaries accounted for 85% of the enrollment decline in 2017 and all of the enrollment decline in 2018, which was offset by a small increase in subsidized enrollment, the report states.

While some states saw unsubsidized enrollment drop by less than 1%, others saw more dramatic changes, including six states where unsubsidized enrollment declined by more than 70% between 2016 and 2018, according to the report. Nationwide, unsubsidized enrollment dropped by 40%, or 2.5 million people, during that period, CMS said. 

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

An additional 2.3 million people had employer-sponsored insurance in 2017, but 1.9 million fewer people had coverage through Medicaid, CHIP, or the ACA marketplaces.

The uninsured rate in Medicaid expansion states held at 7.6%, but grew from 13.7% to 14.3% in non-expansion states, which also lost marketplace coverage at twice the rate of expansion states.

The coverage losses were felt across all age groups and incomes, although non-Hispanic white and black nonelderly people, those with at least some college education, and people living in the South and Midwest saw disproportionate coverage losses.


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