By Victoria Moran, J.D., M.H.A.
The National Center for Health Statistics (NCHS) released its estimates of health insurance coverage for 2017, finding no significant change from the 2016 uninsured rate (9.1 percent in 2017 versus 9.0 percent in 2016). Relying on the National Health Interview Survey (NHIS) data, the NCHS found that 19.3 million fewer people lacked coverage in 2017 compared to 2010. There was a decrease in percentage of people under age 65 enrolled through the health insurance marketplace or state-based exchanges set up under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) since the fourth quarter of 2016, but it was not significant. Adults residing in states that expanded Medicaid under the ACA were less likely to be uninsured than those in nonexpansion states (NCHS Health Insurance Coverage, May 22, 2018).
Age. There was no significant change in the percentage of uninsured from 2016 through 2017 for adults aged 18 to 64. At the time of the NHIS, 12.8 percent were uninsured, 19.3 percent had public coverage, and 69.3 percent had private health insurance. Adults aged 25 to 34 were twice as likely to be uninsured as adults aged 45 to 64. Among children aged 0 to 17 years, 5 percent were uninsured, 41.3 percent had public coverage, and 55 percent had private health insurance.
Poverty status. Among the three poverty status groups (poor, near poor, or not poor), the greatest decrease in uninsured since 2013 has been seen among adults who were near poor or poor. There has been no significant change in the rate of poor or near poor from 2015 through 2017, but there was an increase among the not poor adults from 2016 to 2017.
Race and ethnicity. There were significant decreases in the percentage of uninsured adults from 2013 through 2017 among Hispanic, non-Hispanic black, non-Hispanic white, and non-Hispanic Asian adults. There was an increase in the percentage of uninsured Hispanic adults from 2016 to 2017, but it was not significant.
Private exchange coverage. At the time of the NHIS, 65.4 percent of people under age 65 had private health insurance, with 3.7 percent of plans obtained through the marketplace or state-based exchanges. There was a decrease in enrollment in the marketplace or state-based exchanges between the fourth quarter of 2016 and 2017 for all persons under age 65, but it was not significant.
State Medicaid expansion status. The ACA provided states with the option to expand Medicaid coverage to low income persons. In 2017, people aged 18 to 64 in Medicaid expansion states were less likely to be uninsured than those in nonexpansion states. The percentage of uninsured adults in expansion states decreased from 18.4 percent in 2013, to 9.1 percent in 2017. Adults in states with a Federally Facilitated Marketplace were more likely to be uninsured than states with state-based exchanges or a partnership marketplace. The rate of uninsured adults in nonexpansion states decreased from 2013 to 2015 (22.7 percent to 17.5 percent), but increased from 2015 to 2017 (17.5 percent to 19 percent).
HDHPs and CDHPs. Additionally, 43.7 percent of persons under age 65 with private health insurance were enrolled in a high-deductible health plan (HDHP), and enrollment in HDHPs increased from 39.4 percent in 2016, to 43.7 percent in 2017. Enrollment in a consumer-directed health plan (CDHP) (an HDHP with a health savings account) and an HDHP without a health savings account also increased from 2016 to 2017.
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