Uninsured rate stays stable in 2018

Dive Brief:

• The percentage of people without health insurance remained relatively steady over the past year despite efforts to repeal the Affordable Care Act and attempts to curb coverage in Washington and at state levels.
• The latest statistics from the CDC show that from January to March of this year 28.3 million people (8.8%) were uninsured. That’s compared to 29.3 million people (9.1%) a year ago. There are 20 million fewer people without insurance compared to 2010, when the ACA was enacted.
• More consumers shifted to high-deductible health plans (HDHPs) in the first quarter. The report found that nearly half (47%) of Americans under age 65 with private health insurance had a high-deductible plan, an upward trend since 2010.

Dive Insight:

CDC said 12.5% of adults aged 18-64 didn’t have insurance in the first three months of 2018. Nearly 20% had public coverage and 70% were covered by private health insurance. Of the 138.6 million adults with private health insurance, 8.3 million of them (4.2%) received coverage through ACA exchanges.

Nearly 5% of children were uninsured, 42% had public insurance and almost 55% had private health insurance coverage.

A person’s race continues to play a factor in health insurance. Nearly one-quarter of Hispanics lacked coverage in the first quarter. The Hispanic population has seen significant decreases in the percentage of uninsured adults since 2013 when it stood at more than 40%, but the percentage is still higher than other groups. The percentage decreased another three percentage points over the past year from 27.2% to 24.2%. The uninsured rates for other groups remained consistent from last year.

CDC also found that people in Medicaid expansion states were less likely to be uninsured compared to non-expansion states. The percentage of uninsured adults in expansion states decreased from 18.4% in 2013 to 8.7% in 2018. Non-expansion states’ rates fell from 22.7% in 2013 to 17.5% in 2015 before increasing to 19% in 2017. There was a slight percentage drop in 2018 (18.4%), which is still more than double the percentage in expansion states.

Meanwhile, in private insurance, payers and employers increasingly turn to HDHPs, which have higher out-of-pocket costs and usually lower premiums. Payers and employers have moved more people into those plans as a way to contain costs and give consumers “more skin in the game.”

CDC found that of the 47% of people enrolled in an HDHP, only 21.3% were in a consumer-directed health plan with a health savings account. About one-quarter had a plan without an HSA, which lets people save tax-free funds for their healthcare. Employers often contribute to those accounts.

CDC said the number of people in a consumer-directed plan tripled from 7.7% in 2010 to 21.3% in 2018, including a jump from 18.2% in 2017 to 21.3% this year. The percentage of people without an HSA didn’t change significantly over the past year. This shows that employers and payers are increasingly providing tools like HSAs to help people afford care.

Out-of-pocket costs remain a concern for Americans and can result in delaying care.

A recent Commonwealth Fund report found that one-third of American adults aren’t very or somewhat confident they can afford to pay for a serious illness. Only about half of people who earn less than $30,150 are confident they can afford that care.

They have reason to worry. Peterson-Kaiser Health System Tracker recently reported that payments for deductibles and coinsurance increased faster than the total cost for covered costs between 2006 and 2016. The report showed that total out-of-pocket spending increased by 54% in that period from an average of $525 in 2006 to $806 in 2016.