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Private health coverage for working-age adults fell amid pandemic, Census data shows - Healthcare Dive

Dive Brief:

  • Private health insurance coverage declined 0.8 percentage points to 71.8% for adults ages 19 to 64 from early 2019 to early 2021, a period reflecting the onset of the COVID-19 pandemic, the U.S. Census Bureau said Tuesday. The drop among working-age people was driven by a 0.6-percentage-point slip in employer-sponsored coverage, to 61.6%.
  • The decrease in private coverage was largely offset by a higher percentage of working-age adults covered by public insurance programs such as Medicaid.
  • As a result, the uninsured rate of 12.7% for the working-age population in early 2021 was not statistically different from the rate in early 2019, the data showed.

Dive Insight:

The Census Bureau report covers a time frame in which the U.S. grappled with an economic recession and periods of high unemployment related to the COVID-19 pandemic. While there was no significant change in the overall rate of health insurance coverage between March 2019 and March 2021, the percentage of working-age adults enrolled in public insurance programs increased at a time when many people lost their jobs and likely lost their private insurance plans.

The finding that the overall rate of uninsured held steady is in line with research from the Urban Institute. This is due in large part to a pause on Medicaid disenrollment the federal government enacted to protect people during the pandemic. Also, Affordable Care Act subsidies were bolstered and an ACA special enrollment period was established.

As private insurance coverage rates declined among those 19 to 64, the number of people in that age group with public insurance rose to 17.7% in March 2021 from 17.1% in March 2019. The percentage of working age people covered by Medicaid increased to 14.3% from 13.4%, while the number on Medicare declined to 3.9% from 4.1%.

People of working age who purchased private insurance directly fell to 8.4% in 2021 from 8.7% in 2019.

Overall in 2020, 91.4% of Americans had health insurance for all or part of the year, but 28 million were uninsured, the Census Bureau said. Most with insurance (66.5%) had private coverage; public coverage was held by 34.8% (some people may have had more than one type of insurance). Employment-based insurance covered 54.4% of the population.

The Census Bureau also looked at the effect of full-time versus part-time work status on insurance coverage, as the data suggested many employees shifted to part-time or part-year work in 2020. It found that those who worked less than full time year-round were less likely to be covered by private insurance (66.7%) in 2020 than in 2018 (68.5%). On the other hand, 87% of full-time workers had private insurance in 2020, up from 85.1% two years before.

Among working-age adults whose income was below the poverty level, private coverage rose slightly to 27.5% between 2019 and 2021, while public coverage declined to 49.1% from 50.7%.

But more children under age 19 in poverty were uninsured in 2020 than in 2018. Uninsured rates for children under the age of 19 in poverty climbed to 9.3%, compared to 7.8% in 2018.