Share of Americans with insurance falls despite record Obamacare enrollment

 The proportion of Americans with health insurance coverage fell last year even as a record number of people signed up for insurance through the Affordable Care Act (ACA) marketplace, according to new federal data.

The share of Americans who had health insurance for all or part of the year in 2023 was 92 percent, a slight drop from the 92.1 percent seen in 2022, according to a report from the U.S. Census Bureau released Tuesday.  

About 26.4 million Americans — 8 percent of the country — did not have insurance at any time last year, according to the report, which officials said was not statistically different than the year before.  

But a breakdown of uninsured rates in the report shows a drop in coverage among Americans under 45, while more older Americans enrolled in health insurance that year.   

In 2023, 5.8 percent of Americans under the age of 19 did not have health insurance, a very slight increase from the 5.4 percent of teens without healthcare coverage the year before, the data show.  

This decline in health insurance coverage among children is due to a drop in employer coverage that was “not offset by increases in Medicaid or Marketplace coverage for children,” according to Jennifer Tolbert, director of state health reform and deputy director of the program on Medicaid and uninsured at KFF.  

The share of adults aged 19 to 25 and 26 to 34 without health insurance increased very slightly in the same period, rising from 14 to 14.1 percent and 12.5 to 12.6 percent, respectively.  

Meanwhile, the number of uninsured Americans between the ages of 35 to 44 rose from 11.2 to 11.7 between 2022 and 2023. 

Data from the Census report comes from the current population survey (CPS), a monthly survey conducted with the Bureau of Labor Statistics.

This survey might not capture the full impact of changes in insurance coverage in 2023, according to Tolbert.

The CPS only considers someone uninsured if they lack coverage for the entire year.

“Medicaid continuous enrollment that was in place during the pandemic ended in March 31, 2023, and since April 2023, states have disenrolled over 25 million people from Medicaid,” Talbot wrote in a KFF quick takes post. 

Many people who were disenrolled eventually re-enrolled into the program or chose another health insurance coverage, but a KFF survey found that 8 percent of people who were disenrolled became uninsured.

“However, these newly uninsured individuals may not have been counted as uninsured in the 2023 CPS data because they were covered by Medicaid for part of the year,” Talbot added.

The report comes the same day the Department of Treasury released data on how many Americans have received health insurance through the ACA marketplace.

The new figures from the Treasury Department confirm numbers released by the Centers for Medicare and Medicaid Services in January.

More than 20 million Americans have signed up for health insurance coverage through the ACA marketplace this year, the highest “point-in-time” enrollment to date, according to new data released by the Treasury Department Tuesday.  

A total of 49.4 million people enrolled in ACA marketplace coverage, also referred to as Obamacare, at some point over the past decade, according to a statement from the agency. 

That means nearly one in seven Americans has signed up for health insurance coverage through the ACA marketplace since 2014.  

The number of first-time enrollees reached an all-time annual high of 7.9 million in 2014, the first year Americans were able to purchase health insurance through the marketplace after the ACA was passed in 2010, according to the data.  

The data show that first-time enrollee numbers decreased yearly from 2014 to 2019, and began to rise slightly during the COVID-19 pandemic in 2020. Enrollment more robustly increased beginning in 2021 after expansions were made to the premium tax credit under the American Rescue Plan Act passed that year, according to a statement from the Treasury Department.  

States without Medicaid coverage have higher rates of marketplace health insurance coverage enrollment than those with expanded Medicaid, per the department.  

Typically, about 20 percent of residents in states that have not expanded Medicaid have enrolled in an ACA marketplace health insurance, compared to 12 percent of people in Medicaid expansion states.  

Florida is the state with the largest percentage of residents — 28.7 percent — who have ever enrolled in an ACA marketplace health insurance in the past 10 years, according to the data.  

Georgia and Utah have also had high enrollment through the marketplace, with about 20 percent of their populations having signed up for Obamacare at some point.  

The average cost of premiums for a year of ACA marketplace health insurance enrollment is now $800, a senior administration official said during a call with reporters. 

https://thehill.com/policy/healthcare/4871559-health-insurance-coverage-2023/