Young Adults: Who's Insured?

In 2019, there were 30 million uninsured people in the US, with 24 million of those being lawfully present in the country and 6 million being undocumented immigrants. While the number of uninsured people dropped in 2022 to 25.6 million, the number of people under 30 who are insured is unclear. However, it is evident that the number of uninsured people in the US has been fluctuating over the years. The rate of uninsured US citizens rose from 8.6% in 2016 to 9.2% in 2019, with the number of uninsured people increasing by 2.3 million or 8% during that time. The rate of uninsured individuals further increased to 15.5% in 2018, translating to an increase of four million uninsured people nationwide. While the number of uninsured people decreased to 25.6 million in 2022, it is evident that the number of people under 30 who are insured is subject to change and is dependent on various factors.

How many people are insured in the US?

Health insurance coverage in the US is provided by several public and private sources. In 2019, the total US population was approximately 330 million, with 59 million people aged 65 and over covered by the federal Medicare program. Of the 273 million non-institutionalised persons under 65, 159 million had employer-based coverage, 84 million had non-employer-based coverage, and 30 million were uninsured. This means that during 2019, 89% of the non-institutionalised population had health insurance coverage.

The number of uninsured people in the US has fluctuated in recent years. In 2012, there were 45.6 million people in the US without health insurance, which was 14.8% of the under-65 population. Following the implementation of the Affordable Care Act (ACA) in 2013, this figure fell by 18.3 million to 27.3 million by 2016 (8.6% of the under-65 population). However, this improvement began to reverse under President Trump, with the number of uninsured people rising to 29.6 million in 2019 (9.2% of the population).

In 2021, the number of uninsured people decreased again, with 27.2 million people (8.3% of the population) not having health insurance at any point during the year. This trend continued into 2022, with 92.1% of people (304 million) having health insurance at some point during the year. Of these, 65.6% had private health insurance coverage, and 36.1% had public coverage. The most common type of health insurance coverage was employment-based, covering 54.5% of the population for some or all of the calendar year.

While the number of uninsured people in the US has decreased overall in recent years, it remains a significant issue. In 2022, there were still 25.6 million non-elderly uninsured individuals, and the uninsured rate among children under 19 was 5.1%. Lack of health insurance is associated with increased mortality, with an estimated 30-90,000 deaths per year linked to lack of coverage.

What is the impact of the Affordable Care Act on insurance coverage?

The Affordable Care Act (ACA) was signed into law by then-President Barack Obama in March 2010. Formally known as the Patient Protection and Affordable Care Act and commonly referred to as Obamacare, the law includes a list of healthcare policies intended to expand access to health insurance to millions of uninsured Americans. The law expanded Medicaid eligibility, created health insurance exchanges, mandated that Americans purchase or otherwise obtain health insurance, and prohibited insurance companies from denying coverage due to pre-existing conditions.

The ACA was designed to reform the health insurance industry and help reduce the cost of health insurance coverage for individuals who qualify. The law includes premium tax credits and cost-sharing reductions to help lower expenses for lower-income individuals and families. The ACA requires most insurance plans, including those sold on the Health Insurance Marketplace, to cover a list of preventive services at no cost to policyholders that include check-ups, patient counselling, immunisations, and numerous health screenings.

The ACA's impact on insurance coverage has been significant. The law expanded Medicaid coverage for low-income individuals and allowed young adults to remain on their parents' policies until age 26. As of September 2022, 39 states and the District of Columbia had exercised that option. The ACA also created state- or multi-state-based insurance exchanges to help individuals and small businesses purchase insurance.

The ACA has also improved access to care. The law reduced reports of costs being a barrier to seeking care and increased the likelihood of having a primary care doctor. The gains in these outcomes are modestly larger in Medicaid expansion states than in non-expansion states, implying that they are mostly attributable to the nationwide components of the ACA.

The ACA has also had an impact on self-assessed health. The law increased the probability of reporting excellent health and reduced days in poor mental health. Improvements in self-assessed health at lower points of the distribution also emerged in 2016. Most of these gains appear to come from the non-Medicaid expansion components of the law.

How does insurance coverage vary by state?

Health insurance coverage varies significantly by state in the US. As of 2022, 92.1% of people, or 304 million, had health insurance, with private health insurance coverage being more prevalent than public coverage. However, the number of uninsured individuals varies widely by state, with some states having much higher uninsured rates than others. For example, in 2017, Texas had the highest number of uninsured people at 17%, followed by Oklahoma, Alaska, and Georgia. In contrast, states like Massachusetts, Vermont, and Hawaii had much lower uninsured rates.

Several factors contribute to these differences in insurance coverage across states. One key factor is the expansion of Medicaid under the Affordable Care Act (ACA). States that expanded Medicaid under the ACA generally had lower uninsured rates than those that did not. For instance, in 2018, states that expanded Medicaid had an average uninsured rate of 8%, while states that did not expand Medicaid had an average rate of 15%.

Another factor influencing insurance coverage rates is the economic conditions and demographics of each state. For instance, the South and West regions tend to have higher uninsured rates compared to the North and East. Additionally, lower-income adults are more likely to be uninsured than higher-income adults, and non-citizens are more likely to be uninsured than citizens.

The availability of employer-sponsored insurance also varies by state. Recent trends show a decline in employer-sponsored health insurance benefits, with smaller companies becoming less likely to offer health benefits to their employees. This decrease in employer-sponsored insurance can contribute to higher uninsured rates in certain states.

Furthermore, insurance requirements and minimums differ from state to state. While car insurance is mandatory in almost every state, with nearly all states requiring liability coverage for property damage and bodily injury, there are variations in the specific types of coverage required. For example, Maine is the only state that mandates medical payments coverage, while Florida only requires liability coverage for property damage and PIP coverage.

Overall, the variation in insurance coverage by state is influenced by a combination of factors, including Medicaid expansion, economic conditions, demographics, the availability of employer-sponsored insurance, and differences in insurance requirements and minimums. These factors contribute to the diverse landscape of insurance coverage across the United States.

What are the consequences of being uninsured?

Being uninsured can have a range of consequences, affecting an individual's health, finances, and overall quality of life. Here are some detailed paragraphs outlining the potential consequences of being uninsured:

Impact on Health:

Uninsured individuals often face barriers in accessing timely and adequate healthcare services. They are more likely to delay or forgo medical care due to the high cost of treatment and may not have a regular healthcare provider. This can lead to a lack of preventive care, such as cancer screenings or chronic disease management, increasing the risk of undetected or untreated health issues. The lack of health coverage can result in poorer health outcomes, including poorly managed chronic conditions, undetected cancers, and avoidable deaths.

Financial Implications:

When uninsured individuals seek medical care, they often face unaffordable medical bills, which can quickly lead to significant medical debt. Uninsured individuals, who are often from low- or moderate-income households, may struggle to pay these bills, leading to financial instability. They may deplete their savings, face difficulties in paying living expenses, or be forced to borrow money. The cost of healthcare can also cause uninsured individuals to delay or avoid filling necessary prescriptions, further compromising their health.

Access to Healthcare:

The lack of health insurance can result in reduced access to healthcare services and providers. Uninsured individuals may not have a consistent healthcare provider and may rely on emergency rooms or urgent care facilities for their medical needs, which can be costly and inefficient. They may also face challenges in finding providers who offer discounted or charity care, particularly in rural areas where healthcare resources are limited.

Quality of Life:

Being uninsured can negatively impact an individual's quality of life in several ways. The stress and anxiety associated with managing medical bills and debt can affect their mental health and overall well-being. Additionally, the lack of access to preventive and timely medical care can lead to untreated health conditions, causing physical discomfort and a decline in overall health and quality of life.

Consequences for Society:

The consequences of being uninsured extend beyond the individual level and have broader societal impacts. When a significant portion of the population is uninsured, it affects the overall health and productivity of society. Businesses may experience higher employee absenteeism or early retirements due to health reasons. The healthcare system may struggle with bad debt and inefficient care for the uninsured, and society may lose the economic benefits that come from having a healthy and productive population.

What are the demographic characteristics of the uninsured?

Demographic Characteristics of the Uninsured

The demographic characteristics of the uninsured population in the United States are varied and influenced by several factors, including age, income, race and ethnicity, citizenship status, and geographical location. Here is an overview of these characteristics:

• Age: Nonelderly adults, typically those under 65, are more likely to be uninsured than children. Young adults, especially those aged 19–25, have historically had higher uninsured rates, with a sharp drop-off in coverage when they age out of their parents' insurance policies at 26. However, children living in poverty are more likely to be uninsured than their higher-income peers.
• Income: Most uninsured individuals belong to low-income or working-poor families. Higher income often correlates with increased access to employer-based insurance or the financial means to purchase private coverage. People with low and moderate incomes have traditionally faced higher uninsured rates due to the lack of insurance offered through their jobs and the inability to afford coverage on their own.
• Race and Ethnicity: Racial and ethnic disparities persist in health coverage. People of colour, particularly Hispanics and American Indian and Alaska Native individuals, are more likely to be uninsured than their White counterparts. This disparity is reflected in the higher uninsured rates among racial and ethnic minority groups.
• Citizenship Status: Noncitizens, including undocumented immigrants, face barriers to accessing health insurance. Their uninsured rates tend to be higher than those of US citizens, partly due to restrictions on eligibility for public programs. Additionally, undocumented immigrants are ineligible for federally funded coverage, further contributing to their uninsured status.
• Geographical Location: The uninsured rates vary across states and regions. States that have not expanded Medicaid under the Affordable Care Act (ACA) tend to have higher uninsured rates. Regionally, the South and West have historically reported higher uninsured rates compared to the North and East.

These demographic characteristics provide insights into the complex factors influencing health insurance coverage in the United States. Understanding these characteristics is crucial for developing effective policies and interventions to reduce the number of uninsured individuals and ensure equitable access to healthcare.

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