The increase in health insurance coverage in 2012 represents a continuing and encouraging reversal in trends: from 2000-2010, the number of uninsured Americans went up each year. Since 2010, as the economy improved and the early features of the Affordable Care Act took effect, the number of uninsured has gone down. The decline in rates of employer-sponsored coverage, which dropped sharply in the previous decade, have leveled off, and public coverage under Medicare, Medicaid, and CHIP has increased. The net result of these two trends is an increase in health insurance coverage.
An estimated 48.0 million people were uninsured in 2012, 2 million fewer than the 50.0 million who were uninsured in 2010, when President Obama signed the Affordable Care Act. The most recent estimates by the Congressional Budget Office (CBO) suggest that by 2016, the expansion of Medicaid and the establishment of the Marketplace under the Affordable Care Act will reduce the number of uninsured Americans by another 25 million.2
Age and Uninsurance
- The estimated percentage of children (under 19) who were uninsured fell from 9.7% in 2011 to 9.2% in 2012 (Table 1), a statistically significant change. The Children's Health Insurance Program Reauthorization Act (CHIPRA), signed by President Obama in 2009, has improved public coverage under Medicaid and CHIP with provisions such as Express Lane Eligibility, which allows states to use information collected for other programs; bonus payments to states that do well in enrolling and retaining eligible children; and automatic eligibility for newborns whose mothers are enrolled.3 Over 4 million more children had public coverage in 2012 than in 2008, while the number with private coverage has remained about the same. However, an estimated 7.2 million children were uninsured in 2012.
- Through 2009, uninsurance rates for 19-25-year-olds were about 5 percentage points higher than those for 26-34-year-olds. The Affordable Care Act’s expansion of dependent coverage, allowing 19-25-year-olds to be covered under a parent’s employer-sponsored or individually purchased coverage, began to take effect in September 2010 and has completely eliminated this coverage gap, although an estimated 27.2% of each age group remain uninsured in 2012 (Table 1). Uninsurance rates for these groups were statistically unchanged from 2011
- Estimates of uninsurance rates for ages 35-44 (21.1%), 45-64 (16.2%), and 65 and older (1.5%), also shown in Table 1, were statistically unchanged from 2011.
- Due to Medicare, the elderly make up a very small proportion of the uninsured (Figure 1). Children, who are eligible for Medicaid or CHIP at higher income levels than parents, also make up a smaller share of the uninsured than of the general population. Young adults (19-34) make up a larger share of the uninsured than of the general population and are a special focus for Marketplace outreach. Adults between 35 and 44 are also somewhat more likely to be uninsured than the general population, while adults between 45 and 64 are about the same proportion of the uninsured and of the general population.
Race/Ethnicity and Uninsurance
- An estimated 29.1% of Latinos were uninsured in 2012 (Table 1). This was a statistically significant 1 percentage point drop from 2011’s 30.1%, but Latinos continue to constitute a much larger share of the uninsured than of the total population.
- An estimated 19.0% of African Americans were uninsured in 2012 (Table 1), statistically unchanged from 2011.
- An estimated 15.1% of Asian Americans were uninsured in 2012 (Table 1). This was a significantly lower rate than 2011’s 16.8%. Due to small sample sizes, however, the Census Bureau recommends combining two or more years of data when analyzing changes in insurance rates for Asian Americans.
- An estimated 11.1% of non-Latino Whites were uninsured in 2012 (Table 1), statistically unchanged from 2011.
Figure 1. Profile of the Uninsured vs. Total Population by Age, 2012
Source: ASPE calculations from Carmen DeNavas-Walt, Bernadette D. Proctor, and Jessica C. Smith, U.S. Census Bureau, Current Population Reports, P60-245, Income, Poverty, and Health Insurance Coverage in the United States: 2012, U.S. Government Printing Office, Washington, DC, 2013 (http://www.census.gov/prod/2013pubs/p60-245.pdf), accessed September 17, 2013.
Employment Status and Uninsurance
- Among 18-64-year-olds, an estimated 15.5% of full-time workers and 27.7% of part-time workers were uninsured. These rates were statistically unchanged from 2011.
- Also among 18-64-year-olds, the estimated share of nonworkers who were uninsured dropped from 26.7% in 2011 to 25.8% in 2012, a statistically significant change.
Household Income and Uninsurance
- In 2012, as in previous years, people living in lower-income households were more likely to be uninsured than people living in higher-income households. Estimated uninsurance rates were 24.9% for people in households with less than $25,000 in income, compared with 21.4% for people in households with income of $25,000 to $49,999, 15.0% for people in households with income of $50,000 to $74,999, and 7.9% for people in households with income of $75,000 or higher.
- These rates were statistically unchanged from 2011.
- Beginning in January 2014, many lower and middle income families will be eligible to receive affordable health insurance, either by enrolling in an expanded Medicaid program or by purchasing coverage in the Health Insurance Marketplace. Families purchasing coverage in the Marketplace may be eligible for tax credits and cost-sharing subsidies.