Health insurance in the United States is a critical component of access to healthcare. A significant portion of the population remains uninsured despite various healthcare reforms and the expansion of government programs like Medicaid.
According to the latest Census data, the uninsured rate decreased year on year, yet the discrepancies driven by factors like state legislation and socioeconomic factors remain.
The uninsured population faces substantial barriers to accessing healthcare services, resulting in delayed care, increased health disparities, and financial strain on individuals and the healthcare system.
7.9% of the population was uninsured.
The uninsured rate among working-age adults (19-64) decreased by 0.8 percentage points to 10.8% in a year.
Hispanic adults had a decrease in the uninsured rate by 1.7 percentage points to 23.4%.
The uninsured rate for working-age Black adults decreased by 1.2 percentage points to 11.4%.
White, non-Hispanic adults aged 19-64 saw a decrease in the uninsured rate by 0.7 percentage points to 6.8%.
Native-born adults aged 19-64 had an uninsured rate of 8.2%, a decrease from 9.1% the previous year.
Naturalized citizens aged 19-64 experienced a decrease in the uninsured rate from 10.3% the previous year to 8.8%.
For children under 19, the uninsured rate for non-Hispanic Whites increased to 4.1% in 2022.
Foreign-born children had an uninsured rate of 20.6%.
Children living in non-expansion states had an uninsured rate of 8.1% compared to 4.1% in expansion states.
Overview of Health Insurance Coverage
In 2022, the rate of health insurance coverage in the United States showed a slight improvement from previous years.
According to the US Census Bureau, 92.1% of people had health insurance at some point during the year, marking an improvement from 91.7% in 2021. This incremental rise reflects ongoing efforts to expand Medicaid, Medicare, and private coverage.
Private health insurance remains the most prevalent form of coverage, with 65.6% of the population covered in 2022, followed by public coverage at 36.1%. Among the various types of health insurance, employment-based insurance was the most common, covering 54.5% of the population.
Employment-based insurance was the most common, covering 54.5% of the population, followed by Medicaid (18.8%) and Medicare (18.7%).
Uninsured Rates by State
The variation in health insurance coverage across the United States is influenced by urbanization level, state Medicaid expansion status, and regional differences. People living in Medicaid non-expansion states, nonmetropolitan areas, and the West South Central region are more likely to be uninsured.
Additionally, state-level variations reveal significant disparities in health insurance coverage, with certain states exhibiting notably higher or lower uninsured rates, reflecting the complex interplay of policy, demographics, and socioeconomic factors.
What is an expansion state?
Impact of Urbanization Is Undeniable
Among the population aged between 18 and 64, uninsured rates were higher in large central metro counties (13.9%) compared to large fringe metro (10.1%), medium and small metro (64.9%), and nonmetro counties (59.8%).
We saw that private coverage was more prevalent in large fringe metro counties (73.8%) compared to other urbanization levels. Conversely, public coverage increased with decreasing urbanization, being lowest in large fringe metro (18.5%) and highest in nonmetro counties (30.0%).
Unsurprisingly, expansion states are in better condition than non-expansion states
Adults (18-64 years) in expansion states are less likely to be uninsured (9.1%) and more likely to have both private (68.5%) and public coverage (25.0%) than those in non-expansion states.
Likewise, children in expansion states are also less likely to be uninsured (3.1%) compared to those in non-expansion states (6.4%).
State-Specific Insights
The number of uninsured adults is significantly higher in Florida, Georgia, Tennessee, and Texas compared to the national average.
States like California, Kentucky, Louisiana, Michigan, New York, and Virginia had higher public coverage rates than the national average. Conversely, The District of Columbia, Illinois, Massachusetts, Minnesota, Pennsylvania, and Wisconsin had higher rates of private insurance.
Regional Estimates
Higher uninsured rates were noted in the South Atlantic (13.4%) and West South Central (18.7%) regions compared to the national average.
The New England, Middle Atlantic, East North Central, West North Central, and Pacific regions had lower uninsured rates than the national average.
Public coverage was higher in the East South Central and Pacific regions, while marketplace coverage coverage was higher in the New England, Middle Atlantic, East North Central, and West North Central regions.
Children's coverage by state
Uninsured rates were higher than the national average in Florida and Texas; and lower in Maryland and New York.
Public coverage among children was noted to be higher in Arkansas, Louisiana, and Michigan; and lower in Minnesota, whereas private coverage was higher in Colorado and Minnesota; and lower in Arkansas, Florida, Georgia, Louisiana, and Texas.
Uninsured Population Demographic Characteristics
The uninsured rates vary significantly across different age groups, ethnicities, and socioeconomic circumstances. Adults aged 19 to 64 represent the largest portion of the uninsured population, with higher rates observed among Hispanic and Black communities.
Coverage by Age Groups
Older adults (65+) and children (under 19) were more likely to have health insurance, mainly due to factors like fulfilling the Medicare or Medicaid eligibility criteria. Notably, the uninsured rate among children below the age of 19 has actually increased from 5% in 2021 to 5.4% in 2022.
The uninsured rate among working-age adults (19 to 64) decreased by 0.8 percentage points to 10.8% between 2021 and 2022.
Coverage by Ethnicity
Hispanic and Black populations experienced higher uninsured rates compared to White and Asian populations. From 2019 to 2021, Hispanic individuals saw a mere one percentage point improvement in their uninsured rate.
The black population has experienced a 1.3 percentage point increase from 2021 to 2022, whereas the Hispanic population merely had 0.8 points of improvement. Both populations still experience much higher uninsured rates, and disparities remain pronounced.
The situation for children is even worse
Non-Hispanic White and Black children saw an increase in the uninsured rate from 3.4% in 2021 to 4.1% and from 4.3% to 4.7%, respectively, in 2022, while rates for Asian and Hispanic children remained statistically unchanged.
Coverage by Socioeconomic Groups
Children in poverty had an uninsured rate of 8.9%, showing a significant disparity based on economic status.
Additionally, the uninsured rate for working-age adults in non-expansion states was significantly higher than in expansion states, highlighting the impact of policy on coverage.
Reasons and Impacts of Being Uninsured
The primary reason cited by the uninsured for not having coverage is the high cost of health insurance premiums.
Additionally, eligibility issues, particularly among low-income adults in states that have not expanded Medicaid, contribute to the lack of coverage.
The COVID-19 pandemic has also had an impact, with many people losing their employer-sponsored insurance due to job losses.
Impacts of Being Uninsured
Access to Healthcare
The lack of insurance significantly affects individuals' ability to access necessary medical care. Uninsured people are more likely to delay or forgo preventative care and treatments for chronic conditions, leading to worse health outcomes and higher costs in the long run.
In 2022, a significant portion (64%) of nonelderly adults without insurance reported the high cost of coverage as the reason for being uninsured.
A lack of access to employer sponsored coverage is common among the uninsured, and notably, adults with low incomes in states that have not expanded Medicaid often find themselves without eligibility for financial help for insurance.
Furthermore, undocumented immigrants do not qualify for federally funded insurance programs, such as Medicaid coverage or Marketplace plans.
Financial Implications
Uninsured individuals face substantial financial challenges, including unaffordable medical bills and debt. The burden of medical expenses is particularly heavy on families with low to moderate incomes, who are already struggling to meet their basic needs.
In 2022, when individuals without insurance sought medical care, they frequently encountered medical bills that were beyond their financial reach.
Nonelderly adults without insurance were almost two times more likely than insured individuals to report challenges in managing health care expenses.
Due to the majority of uninsured people having low to moderate incomes and minimal savings, these costs often lead to medical debt.
Policy Implications and Future Directions
Medicaid Expansion
The expansion of Medicaid in more states could significantly reduce the number of uninsured individuals. Studies have shown that Medicaid expansion leads to increased coverage, improved access to care, and better health outcomes for low-income populations.
Affordable Care Act (ACA) Marketplace
Enhancements to the ACA Marketplace, such as increased subsidies and more affordable insurance options, could further reduce the uninsured rate. Efforts to simplify the enrollment process and extend enrollment periods would also help reach more uninsured individuals.
Conclusion
While progress has been made in reducing the number of uninsured Americans, millions remain without coverage, facing significant barriers to accessing healthcare.
The significant difference in uninsured rates between Medicaid expansion and non-expansion states highlights the profound impact of state-level policy decisions on health insurance coverage. Furthermore, the reliance on employment-based insurance underscores the need for policy discussions on diversifying Americans' access to health insurance, particularly for working-age adults who may not have stable employment or are employed in sectors less likely to offer health benefits.
Addressing the high cost of health insurance, expanding Medicaid in non-expansion states, and enhancing the ACA Marketplace are critical steps toward achieving universal coverage. As policymakers and healthcare stakeholders continue to debate and implement reforms, the goal of reducing the uninsured population remains central to improving the health and well-being of all Americans.
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