By Surabhi Dangi-Garimella, Ph.D.
According to data released by the U.S. Census Bureau, the COVID-19 pandemic, surprisingly, did not have a huge impact on the uninsured rate in the country. The year 2020 saw only a 0.1% increase in the number of uninsured individuals compared to 2018, and a 0.5% increase compared to 2019. Considering the pandemic-related disruptions in data collection in 2020, the Census bureau used 2018 numbers for primary comparison.
Overall, enrollment in any health plan saw a 0.1% reduction in 2020 compared with 2018. However, a deeper dive into the numbers shows a slight shift from private to public health insurance enrollment between in 2020.
- Employment-based insurance saw a 0.5% decrease in 2020 (54.4%)
- Marketplace coverage remained steady at 3.3%
- Medicare saw a 0.6% increase in 2020 (18.4%)
- Medicaid saw a 0.1% decrease in 2020 (17.8%)
Demographics
Below is the breakdown on insurance coverage in 2020 based on age and socioeconomic factors.
Age
There were no changes in the uninsured rate based on age. In both 2018 and 2020, the highest number of insured were either in the over 65 years age group or under 19 years age group. The uninsured rates (%) were:
- 5.5 (2018) and 5.6 (2020) among under 19 years
- 14.3 (2018) and 14.4 (2020) among 19-25 years
- 13.9 (2018) and 14.2 (2020) among 26-34 years
- 12.5 (2018) and 12.4 (2020) among 35-44 years
- 9.3 (2018) and 9.6 (2020) among 45-64 years
- 0.9 (2018) and 1.0 (2020) among 65 and older
Race
Overall, the insurance rate was lowest among Hispanics (18.3% were uninsured), followed by Blacks (10.4%), Asians (5.9%), and non-Hispanic Whites (5.4%). With respect to specific categories of insurance:
- Public health coverage included:
- 41.4% Blacks
- 35.9% Hispanics
- 33.8% non-Hispanic Whites
- Private coverage included:
- 73.9% non-Hispanic Whites
- 72.4% Asians
- 54.6% Blacks
- 49.9% Hispanics
Non-Hispanic Whites were the only population to see a shift in insurance status—a 0.9 percentage points reduction in private coverage and a 0.6 percentage points increase in public coverage.
Economic status
Work status—either full-time, less than full-time, or not working during a calendar year—influenced enrollment in private health insurance, with full-time workers leading the chart (87%), followed by less than full-time (66.7%), and those who did not work at all (52.2%) in 2020. On the flip side, public insurance was more common among non-workers (39.1%) compared to full-time workers (6.1%) in 2020.
Those living in poverty were least likely to have private coverage (23.2%) in 2020. This rate increased in the higher income-to-poverty ratio, with 88.2% of those earning at or above 400% of the poverty line being covered by private health insurance. The numbers were reversed for public health insurance, with those living in poverty leading the chart.
A discrepancy noted in the report is that the Census data did not show an increase in Medicaid enrollment, which contradicts CMS data that showed a 15.6% increase in Medicaid and CHIP enrollment. CMS data is collected from state insurance records, whereas the Census data are self-reported by individuals.
Surabhi Dangi-Garimella, Ph.D. is a biologist with academic research experience, who brings her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.
