More Americans go without health coverage

The number of people without health insurance increased from the previous year for the first time since the Great Recession, according to new figures released Tuesday by the U.S. Census Bureau.

“The poverty rate went down, the economy is doing well, and yet we’re still seeing more people uninsured,” said Laura Skopec, a senior researcher for the nonprofit Urban Institute’s Health Policy Center.

In 2018, 27.5 million people, or 8.5 percent of the population, did not have coverage at any time during the year. That’s 1.9 million people more than in 2017, when 7.9 percent did not have health insurance. The last time the United States saw a yearly increase large enough to be statistically significant was 2009, the final months of the Great Recession.

In Michigan, the rate of people without coverage was 5 percent. That ranks it 42nd in the nation.

Texas leads with nearly 18 percent of residents uninsured. Massachusetts had the fewest uninsured residents at less than 3 percent.

Most states did not see a significant shift in coverage rates. Those with increased health insurance rates saw changes of just less than 1 percentage point. Only three states saw uninsured rates drop more than the survey’s margin of error: Wyoming, South Carolina and New York.

“You don’t see a strong pattern in terms of which states are increasing and which are decreasing coverage,” Skopec said of the new data. “There are three bright spots, but everybody else is either losing coverage or just maintaining.”

Although fewer Americans had public health coverage in 2018 — mostly due to a drop in Medicaid recipients, the number of people with private insurance was largely the same.

It could be, at least in part, that some Americans who lost Medicaid coverage did not replace it with private insurance.

“Some portion of it is mechanical,” Skopec said. “As they get more income, they no longer qualify for Medicaid. When they fall off Medicaid rolls, they don’t get employer coverage or insurance through the marketplaces and they end up uninsured.”

Skopec also pointed to Census data that showed a growing number of middle-income families without coverage. For instance, families of four earning more than $102,000 a year saw the uninsured rate increase, and it did so almost three times more in states without Medicaid expansion.

She said this could be because families who do not qualify for Medicaid and who make too much money to receive a federal subsidy from the marketplace must pay their full premium, and premiums are on the rise nationwide.

“The highly subsidized people are shielded from premium increases,” she said. “But for this group, the 20 percent premium increase is all on you.”

About two-thirds of people surveyed had private health insurance, which most often is provided as a job benefit. But Skopec notes that the likelihood of an employer offering insurance varies widely by state and industry, which can leave some people in a gap where they do not qualify for public assistance but cannot afford to directly purchase coverage on their own.

Since 2014, states have had the option to expand Medicaid to more people, in part to close that gap. Traditionally, the program provided coverage only to low-income parents and people with a disability, not low-income adults without children.

The data reinforced previous findings that states which expanded Medicaid programs to cover more low-income residents have fewer people without insurance and have shrunk the size of that group faster.

The 31 states with expanded Medicaid saw uninsured rates cut nearly in half from 12.6 percent in 2013 to 6.7 percent in 2018. The 19 states that have not expanded Medicaid saw their uninsured rates drop only half as quickly, going from 14.7 percent in 2013 to 10.6 percent in 2018.

Michigan launched expanded Medicaid in April 2014 and has seen its uninsured rate drop 51 percent, which is more than the non-expansion state average of 28 percent. It fell from 11 percent in 2013 to 5 percent in 2018. The state has received federal permission, via a Section 1115 wavier, to tighten who receives expanded Medicaid by implementing new work requirements, which have not yet been implemented.

“Health insurance coverage is an important measure of our nation’s overall wellbeing,” Sharon Stern, assistant division chief at the U.S. Census Bureau, said in a recorded presentation of the new data on Tuesday. “Whether it’s illness, injury, or preventative needs, health insurance provides greater access to medical care, protection from high unexpected costs and more economic stability.”