The coronavirus pandemic caused major economic and health care disruptions; however, unlike during previous downturns, the coverage expansions put in place by the Affordable Care Act (ACA) served as a safety net for people who lost jobs and access to health coverage. The ACA sought to address the gaps in our health care system that left millions of people without health insurance by extending Medicaid coverage to many low-income individuals and providing subsidies for Marketplace coverage for individuals below 400% of the federal poverty level (FPL). In addition, policies adopted during the pandemic, including the requirement that states maintain continuous enrollment for Medicaid enrollees and the enhanced subsidies in the Marketplace, protected people against coverage losses and improved the affordability of private coverage, making it easier for low-income individuals most affected by the pandemic to gain and retain coverage. As a result, after increasing for three straight years from 2017 to 2019, the number of nonelderly uninsured individuals dropped by nearly 1.5 million from 28.9 million in 2019 to 27.5 million in 2021, and the uninsured rate decreased from 10.9% in 2019 to 10.2% in 2021. Show
This issue brief describes trends in health coverage during the second year of the pandemic, examines the characteristics of the uninsured population in 2021, and summarizes the access and financial implications of not having coverage. Using data from the American Community Survey (ACS), this analysis compares health coverage data for 2021 to data for 2019; because of disruptions in data collection during the pandemic, the Census Bureau did not release 1-year ACS estimates in 2020. With policies in place to protect health coverage for people who may have lost jobs and/or income during the pandemic, the number of uninsured decreased in 2021. In 2021, 27.5 million nonelderly individuals were uninsured, a decrease of nearly 1.5 million from 2019. Coverage gains were driven by increases in Medicaid and non-group coverage that offset declines in employer-sponsored coverage and were particularly large among Hispanic people and people in working families.Who are the uninsured? Most uninsured people are in low-income families and have at least one worker in the family. Reflecting the more limited availability of public coverage in some states, adults are more likely to be uninsured than children. People of color are generally at higher risk of being uninsured than White people, though Asian people have the lowest uninsured rate.Why are people uninsured? Despite policy efforts to improve the affordability of coverage, many uninsured people cite the high cost of insurance as the main reason they lack coverage. In 2021, 64% of uninsured adults said that they were uninsured because the cost of coverage was too high. Many people do not have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for financial assistance for coverage. Additionally, undocumented immigrants are ineligible for Medicaid or Marketplace coverage.How does not having coverage affect health care access? People without insurance coverage have worse access to care than people who are insured. One in five uninsured adults in 2021 went without needed medical care due to cost. Studies repeatedly demonstrate that uninsured people are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases.What are the financial implications of being uninsured? The uninsured often face unaffordable medical bills when they do seek care. In 2021, uninsured nonelderly adults were over twice as likely as those with private coverage to have had problems paying medical bills in the past 12 months. These bills can quickly translate into medical debt since most people who are uninsured have low or moderate incomes and have little, if any, savings. How many people are uninsured?After several years of coverage losses prior to the start of the pandemic, the uninsured rate dropped from 2019 to 2021, driven largely by increases in Medicaid coverage as well as increases in non-group Marketplace coverage during the pandemic. Coverage gains were larger among nonelderly Hispanic and Asian people compared to their White counterparts and among low-income individuals and those in working families versus those at higher incomes and those without a worker in the family. The number of uninsured individuals remains well below levels prior to enactment of the ACA. The number of uninsured nonelderly individuals dropped from more than 46.5 million in 2010 to fewer than 26.7 million in 2016, climbed to 28.9 million individuals in 2019 before dropping again to 27.5 million in 2021. We focus on coverage among nonelderly people since Medicare offers near universal coverage for the elderly, with just 441,000, or less than 1%, of people over age 65 uninsured. Key Details:
Who are the uninsured?Most of the 27.5 million people who are uninsured are nonelderly adults, in working families, in families with low incomes and six in ten are people of color. Reflecting geographic variation in income and the availability of public coverage, most uninsured people live in the South or West. In addition, most who are uninsured have been without coverage for long periods of time. (See Appendix Table B for detailed data on characteristics of the uninsured population.)
Why are people uninsured?Most of the nonelderly in the U.S. obtain health insurance through an employer, but not all workers are offered employer-sponsored coverage or, if offered, can afford their share of the premiums. Medicaid covers many low-income individuals; however, Medicaid eligibility for adults remains limited in some states that have not adopted the ACA expansion. With the Medicaid continuous enrollment requirement in place during the PHE, Medicaid coverage increased in many states. While financial assistance for Marketplace coverage is available for many moderate-income people, few people can afford to purchase private coverage without financial assistance. Key Details:
How does not having coverage affect health care access?Health insurance makes a difference in whether and when people get necessary medical care, where they get their care, and ultimately, how healthy they are. While the COVID-19 pandemic affected health care utilization broadly, uninsured adults are far more likely than those with insurance to postpone health care or forgo it altogether because of concerns over costs. The consequences can be severe, particularly when preventable conditions or chronic diseases go undetected.
What are the financial implications of being uninsured?Uninsured individuals often face unaffordable medical bills when they do seek care. These bills can quickly translate into medical debt since most of the uninsured have low or moderate incomes and have little, if any, savings., Key Details:
ConclusionLargely due to policies put in place during the COVID-19 pandemic to stabilize coverage, the number of people without health insurance dropped in 2021. The coverage gains were driven primarily by increases in Medicaid coverage due to the continuous enrollment requirement that has been in effect since the start of the pandemic. The increases in Medicaid as well as smaller gains in nongroup coverage offset declines in employer coverage, leading to the drop in the number of uninsured and the uninsured rate. While the improvements in coverage were widespread, they were particularly large for Hispanic people, those in low-income families, and among people in working families, including those with only part-time workers in the family. The end of the COVID-19 PHE could reverse these recent coverage gains. Once the PHE ends, which is expected sometime next year, states will resume Medicaid redeterminations and will disenroll people who are no longer eligible or who are unable to complete the renewal process even if they remain eligible. As a result, KFF estimates that between 5 and 14 million people could lose Medicaid coverage, including many who newly gained coverage during the pandemic. Recent funding increases for Navigators and other efforts to increase outreach and the availability of enrollment assistance can help people complete the Medicaid renewal process, and if found no longer eligible, transition to other coverage. The continued availability of the enhanced Marketplace subsidies will make that coverage more affordable for people who are disenrolled from Medicaid and may increase the share of people who successfully transition from Medicaid to Marketplace coverage. Still, any large increase in the number of people who are uninsured could undermine improvements in access to care and financial stability that come with having health coverage and could worsen disparities in health outcomes. Which statement best describes the major goal of the healthcare system quizlet?Which statement best describes the major goal of the health care system? Provide care for all patients and family members who are ill or injured.
Which are reasons for the high cost of health care quizlet?What are 9 reasons for high cost in health care?. 3rd party payment.. imperfect market.. growth of technology.. increase in elderly population.. medical model.. multiplayer system.. defensive medicine.. waste and abuse.. Which statement about the Agency for Healthcare Research and Quality is accurate?Which statement about the Agency for Healthcare Research and Quality (AHRQ) is accurate? The AHRQ works to improve the safety of the health care system by publishing clinical guidelines.
Which best describes a health disparity that exists in the United States?Which best describes a health disparity that exists in the United States? Minority groups have a higher prevalence of chronic conditions than Caucasians.
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