New Census Estimates Show 3 Million More Americans Had Health Insurance Coverage in 2012. Sources of Health Insurance Coverage

11/01/2013

As discussed above, an estimated 15.4% of the population was uninsured, and this rate was significantly lower than the 2011 estimate of 15.7% uninsured.  The stabilization of employer-sponsored coverage and the growth in Medicare coverage both contributed to this result.

  • An estimated 54.9% of the population was covered by employer-sponsored insurance in 2012.  This was not significantly different from the rate in 2011.  From 2000 to 2010, the percentage of Americans with employer-sponsored insurance dropped by about 10 percentage points (Figure 2).  The new CPS-ASEC data suggest that the erosion of employer-sponsored insurance leveled off in 2011 and 2012.
  • An estimated 16.4% of the population was covered by Medicaid or CHIP in 2012.  As Figure 2 shows, Medicaid/CHIP coverage grew rapidly from 1999 to 2011, and the number of people covered by these public programs began to exceed both the number of Medicare enrollees and the number of uninsured.  The 2012 rate, however, was statistically unchanged from 2011.
  • An estimated 15.7% of the population was covered by Medicare in 2012.  As the baby boom ages, more Americans turn 65 and become eligible for Medicare.  The share of the population covered by Medicare was higher in 2012 than in 2011 and the increase in the number of individuals covered by Medicare, from 46.9 million to 48.9 million, was also statistically significant.  This year-to-year increase in Medicare enrollment is likely to continue into the middle of the next decade.  
  • An estimated 9.8% of the population was covered by directly purchased private insurance in 2012, statistically unchanged from 2011.  (Directly purchased private insurance is sometimes described as individual market or nongroup coverage).  The percentage of the population with this form of coverage has been very stable over the period shown in Figure 2.
  • An estimated 4.4% of the population was covered by insurance related to current or previous military service in 2012, statistically unchanged from 2011.  The percentage of the population with this form of coverage has grown somewhat over the period shown in Figure 2 but remains small.

Figure 2. Sources of Insurance Coverage, 1999-2012

Figure 2. Sources of Insurance Coverage, 1999-2012

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.


The estimates shown in Figure 2 are based on the percentage of people for whom each source of coverage was reported.  These percentages sum to more than 100 percent because some people report multiple forms of coverage.  Some of the elderly and disabled, for example, are “dual eligibles” enrolled in both Medicare and Medicaid.6   Because the CPS-ASEC asks about coverage in the prior calendar year, people who had different types of coverage in different parts of the year (for example, people who directly purchased individual market coverage and then got jobs providing employer-sponsored coverage) may also report multiple sources of coverage. 

Figure 3 shows the distribution of sources of coverage when individuals with multiple sources of coverage are assigned to one primary source.  The methods we used to assign primary source of coverage to individuals with multiple sources of coverage are explained in the Appendix.


Figure 3. Primary Source of Coverage, 2012

Figure 3. Primary Source of Coverage, 2012

Source: ASPE computations from Current Population Survey Annual Social and Economic Survey (CPS-ASEC) microdata for Calendar Year 2012.


Table 2 compares the number of people reported as having a particular source of coverage with the number to whom that source was assigned as primary coverage.  The difference is most striking for directly purchased private insurance, which is reported for 30.6 million people, but assigned as primary only to the 11.1 million people who reported it as their sole source of coverage.  This estimate is very close to the 10.9 million covered lives in the individual market reported  in the 2012 administrative data submitted by insurers in connection with the Affordable Care Act’s Medical Loss Ratio (MLR) requirements.7

Table 2: Sources of Health Insurance Coverage in 2012
Source Any Primary/Only
  (in millions) (percentage) (in millions) (percentage)
Source: ASPE computations from Current Population Survey Annual Social and Economic Survey (CPS-ASEC) microdata for Calendar Year 2012.
Medicare 48.9 15.7% 48.9 15.7%
Military 13.7 4.4% 9.7 3.1%
Medicaid/CHIP 50.9 16.4% 42.9 13.8%
Employer-Sponsored 170.9 54.9% 150.6 48.4%
Direct Purchase 30.6 9.8% 11.1 3.6%
Outside Household 9.4 3.0% -- --
Uninsured 48.0 15.4% 48.0 15.4%
Total 311.1 119.7% 311.1 100.0%

 

As Table 3 shows, most of the people with directly purchased coverage in the CPS-ASEC data also have something else.  The most common combination is direct purchase and Medicare.  Many Medicare enrollees purchase Medicare Supplemental Health Insurance policies, also known as “Medigap,” to cover costs they would otherwise bear out-of-pocket, 8 and some respondents may have  reported such policies in their CPS-ASEC interviews.  Similarly, persons who reported both direct purchase and employer-sponsored coverage may have been thinking of the wrap-around policies they purchased for services such as dental or vision care that were not covered by their employer plans.  And since the CPS-ASEC asks about coverage over the course of the full calendar year, some of the people reporting multiple forms of coverage in 2012 may have had directly purchased policies for some months and other coverage, such as employer-sponsored coverage from a new job, for other months.  People reporting directly purchased policies along with Medicaid  or CHIP may have bought coverage while waiting for public coverage to kick in.

Table 3: Multiple Coverage Among Direct Purchase Enrollees, 2012
Sources of Coverage Total
(in millions)
% Direct Purchase % Direct Purchase and Any Other % Population

Source: ASPE computations from Current Population Survey Annual Social and Economic Survey (CPS-ASEC) microdata for Calendar Year 2012.

Note: Totals for Direct  Purchase and Employer-Sponsored include people for whom coverage outside the household is reported.

Direct Purchase and Medicare 11.4 37.3% 58.6% 3.7%
Direct Purchase and Military 1.3 4.3% 6.7% 0.4%
Direct Purchase and Medicaid/CHIP 1.7 5.6% 8.9% 0.6%
Direct Purchase and Employer-Sponsored 8.7 28.2% 44.4% 2.8%
Direct Purchase and Any Other 19.5 63.7% 100.0% 6.3%
Direct Purchase Only 11.1 36.3% n /a 3.6%
Direct Purchase Total 30.6 100.0% n /a 9.8%

 

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