The percentage of Americans without health insurance remained steady in 2023, the Census Bureau said Tuesday, near the record low achieved by the Biden administration in 2022 through expansions of public programs, including the Affordable Care Act.
About 8% of Americans were uninsured, a statistically insignificant increase of just 0.1 percentage point over the previous year. However, because of the Census survey’s methodology, the findings likely do not capture the experience of tens of millions of Americans who were cleared from Medicaid after the pandemic-era protections end in the spring of 2023.
Enrollment in Medicaid, the government health program for people with low incomes and disabilities, reached its highest level in April 2023. That was just ahead of what’s called “phase-out,” the process states used to disenroll people from program after the federal government lifted its ban on culling enrollments.
It’s not yet clear what effect the easing has had on insurance coverage, but the Census Bureau will release additional data Thursday from a different survey that may improve the numbers.
“We’re probably at an inflection point,” said Leighton Ku, director of the Center for Health Policy Research at George Washington University. “We’re about to transition into a new season where things are going to be a little bit worse than Medicaid relaxation.”
Medicaid rollout is complete in most states and more than 25 million people are enrolled, according to KFF, a nonprofit health information organization that includes KFF Health News. The Census report, based on surveys conducted earlier this year, only counts people as uninsured if they did not have insurance for all of 2023. So, for example, a person who was on Medicaid in April 2023 before the relaxation began, lost coverage and never regained However, it will count as insured for the entire year.
Many people who were removed from Medicaid successfully re-enrolled or obtained other insurance, such as purchasing the Affordable Care Act or job-based coverage. Others were left uninsured.
Advocates fear the relaxation would cause the uninsured rate to rise as people scramble to find alternative coverage.
But states, private health insurers and advocates launched intense efforts to contact enrollees by phone, email and social media to ensure they had no gaps in coverage.
However, because of the way the Census Bureau reports the uninsured rate, the full impact of the relaxation won’t be known until the 2026 report.
Beyond Medicaid, several other factors boosted the number of Americans with health insurance last year, including a strong economy and near-low unemployment. Most Americans get insurance through their jobs, according to the Census, meaning higher employment usually leads to broader health coverage.
Another key factor: enhanced federal subsidies starting in 2021 that helped lower the cost of private coverage through Obamacare. Enrollment in the Affordable Care Act’s marketplaces will reach a record high of 20.8 million in 2024, according to a Treasury Department report released Tuesday.
But that extra financial aid is set to expire at the end of 2025, creating a flashpoint for whichever party controls power in Washington after November’s election. Democrats want to extend subsidies introduced during the pandemic, while many Republicans want to let them expire.
Before Congress passed the ACA in 2010, the uninsured rate was in the double digits for decades. The rate fell steadily under President Barack Obama, but reversed under President Donald Trump, only to fall again under President Joe Biden.
In addition to expanding subsidies, the Biden administration has increased advertising and the number of counselors helping people sign up for plans during the open enrollment period, which Trump has significantly curtailed.
State efforts to expand coverage to mostly low-income residents are also helping to reduce the number of uninsured Americans. North Carolina, for example, expanded Medicaid eligibility in December 2023, resulting in more than 500,000 additional enrollees.
Decades of research show that expanded health coverage helps individuals and the public as a whole. Health insurance pays for routine care and can protect people from financial ruin due to serious injury or illness.
People who are uninsured are more likely to delay or avoid getting health care, which can lead to relatively minor problems becoming more serious and costly to treat. Covering more people also means more patients can pay their bills, which can improve the financial situation of hospitals and other providers.
Health insurance data published annually by the Census Bureau is considered the most accurate picture of health coverage in the United States. The statewide uninsured figures he plans to release Thursday, based on a larger survey, count people as uninsured if they say they don’t have coverage when contacted. Thus, it will likely provide more insight into the effects of relaxation.
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This article was reprinted by khn.orga national newsroom that produces in-depth health journalism and is one of the core operating programs at KFF – the independent source for health policy research, polling and journalism.
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