Commentary Directory

Health Insurance Data: 2019 Update

Jacob Hess
September 16, 2020

In the upcoming election season, Democrats and Republicans will continue to go head to head over various hot button topics as they jostle for control of the White House and Congress. Healthcare will be one of those topics primed for debate amongst candidates as discussions over "Medicare for All" continue to take center stage. In those debates, potential voters will hear the latest data rattled off as candidates look to bolster their talking points. Those data points will likely come from the Census Bureau's latest edition of the "Health Insurance Coverage in the United States" report which highlights their 2019 findings. Here are some highlights.

The number most likely to be taken from this report is the total number of individuals without health insurance in 2019, and it's a lot more complicated than just a number. The Census Bureau cites two different numbers from two different surveys in the report, the Current Population Survey 2020 Annual Social and Economic Supplement (CPS ASEC) and the American Community Survey (ACS), both conducted by the Census Bureau. The CPS ASEC uninsured total is reported at 26.1 million, a decrease of -1.35 million from the 2018 total of 27.5 million. Of the total population, 8.0% in 2019 were found to be uninsured, down from 8.5% in 2018. The ACS total uninsured count was over 3 million higher than the CPS ASEC count. At 29.6 million in 2019, that survey pointed to an increase of 1.0 million from 28.6 million in 2018. That leads to an increase in the percentage uninsured from 8.9% in 2018 to 9.2% in 2019.

Why the disparity? A clear distinction is made in the footnotes: "In the CPS ASEC, individuals are considered to be uninsured if they do not have health insurance coverage for the entire calendar year. In the ACS, individuals are considered uninsured if they are uninsured at the time of interview." The fact that the CPS ASEC survey has stricter criteria for being uninsured might explain the increase in reported coverage. However, there may also be more of a self-reporting bias in the ACS survey because it involves individuals responding themselves through a questionnaire or a mailed paper form. Regardless of biases, the margin of error on both surveys suggests the magnitude of the 2019 changes could be smaller. Both the 2018 and 2019 CPS ASEC surveys have a margin of error of +/- 0.2% while the difference is -0.5%, and both the 2018 and 2019 ACS surveys have a margin of error of +/- 0.1% while the difference is +0.3%.

The largest disparity between the two surveys looks to be in the private plan counts. The CPS ASEC data shows an increase of almost 3 million in the individuals reporting being insured by any private plan, from 217.9 million in 2018 to 220.8 million in 2019. This translates to total private coverage of 68.0%, up from 67.3%. The increase in private coverage in the ACS survey was just under 200,000, up from 217.6 million in 2018 to 217.8 million in 2019 with coverage mostly flat at 67.5% versus 67.4%. The subcategory that accounted for this disparity the most was employment-based coverage.

Uninsured rates for individuals under 65 increased slightly in 2019. Both 19 to 64-year-olds and 19 and under year olds saw an 0.4% increase in uninsured rates to 12.9% and 5.7% respectively. The uninsured rate for individuals over the age of 65 was essentially unchanged. By race, Hispanic origin groups saw the highest increase in uninsured rates, up from 17.9 in 2018 to 18.7% in 2019. Non-Hispanic Whites and Asians uninsured rate was up slightly from 0.2% to 0.3% while Blacks were virtually unchanged. Uninsured rates continue to vary with poverty rates. Directly from the report, "in 2019, 87.6% of people with an income-to-poverty ratio at or above 400% of poverty had private coverage, compared with 60.1% for those with incomes 100 to 399% of poverty, and 26.6% for those with incomes below poverty." Public coverage was the option chosen by those in poverty at 65.2% versus 21.9% for those at or above 400% of poverty.

The last bit of data compares the uninsured rates of states that expanded Medicaid eligibility and those who didn't. Uninsured rates in non-expansion states were significantly higher than in expansion states. Overall, expansion uninsured rates were 9.8%, an increase of 0.5% from 2018 to 2019, while non-expansion uninsured rates were 18.4%, up 0.7%. Most of the difference here can be explained by a higher increase in the non-expansion uninsured rate for those below 100% of poverty which jumped 1.7%, much higher than the 0.7% increase in expansion states. If anything can be said, Medicaid expansion may have had an impact on uninsured rates for those in poverty.