The number of uninsured adults in the U.S. crept up to 14.5% in 2019, from 13.3% in 2018, according to data from the CDC’s National Health Interview Survey (NHIS).
Put into context, the share of adults 18-64 who were uninsured last year was still much lower than the 20.4% of adults who reported being uninsured in 2013 — 3 years after passage of the Affordable Care Act (ACA).
While she’s not “especially surprised” by the slight uptick in the percentage of uninsured adults, given the “incremental increases” seen in the last few years, Rachel Garfield, PhD, co-director of the Program on Medicaid and the Uninsured for the Kaiser Family Foundation, said it is “troubling” given the turmoil of the last 6 months, between the COVID-19 pandemic and economic downturn.
The survey also found that slightly more men than women, more young adults than older adults, and far more Hispanic adults than non-Hispanic adults lacked insurance. Additionally, more adults in “fair or poor” health were uninsured compared with those who said their health was “excellent, very good, or good.”
When asked their reasons for not having insurance, 73.7% said plans were not affordable. The percentage of adults who found coverage unaffordable increased with age: 66.8% of adults 18-29 compared with 80.9% of those 50-64 stated that cost was a reason they did not have a health plan.
“We have seen pretty consistently, for a very, very long time that most people who are uninsured say that they’re uninsured because of costs,” Garfield said.
While some people expected the ACA to make coverage affordable for everyone, she noted, “there are people who are falling through the cracks in that coverage and [who] still can’t afford health insurance.”
The percentage of older adults who said they could not afford coverage also troubled Garfield, given the ACA’s restriction on underwriting health coverage based on age.
But it’s unclear whether the individual reporting affordability issues actually shopped for a health plan, she said.
The report highlighted other key findings, including:
- 16% of men were uninsured versus 13.1% of women
- 17.5% of adults 18-29 were uninsured versus 10.5% of adults 50-64
- 30.2% of Hispanic adults were uninsured versus 14.3% of non-Hispanic Black and 10.2% of non-Hispanic white adults
- 17.6% of adults who described their health as “fair or poor” lacked insurance, while 14.1% of adults in “excellent, very good, or good” health reported being uninsured
Beyond cost, respondents gave other reasons for not having a health plan: 25.3% said they were not eligible for insurance; 21.3% did “not need or want” coverage; 18.4% said enrollment was “too difficult or confusing”; 18% said they “could not find a plan” that met their needs; and 8.5% said that they had enrolled but their coverage had not started. (Respondents were allowed to provide more than one reason for not having insurance.)
In drilling down into these responses, the survey found that the percentage of adults currently ineligible for insurance was higher, at 30.4%, among Hispanic adults compared with 22.3% of non-Hispanic white adults. The difference in ineligibility between Hispanic and non-Hispanic Black adults, 30.5% versus 25.3%, was not statistically significant, the report noted.
Garfield said she was concerned by the high percentage of adults (21.3%) — including 26.8% of men and 14.8% of women — who said that healthcare coverage was “not needed or wanted,” which is a higher percentage than past surveys.
She suggested that the response may be related to how the question was asked or it may be that “more people are deciding that they don’t want health insurance,” which she noted seemed unlikely.
Garfield was also concerned by the share of adults surveyed who reported trouble finding a plan, and suggested that the issue may be related to the government reducing funding for navigator programs in recent years.
While some policymakers may have thought these supports were no longer needed, “I think what this data is showing is in fact a sizeable share of people are still having trouble … finding a plan that meets their needs.”
The analysis released Wednesday leverages data from the NHIS’s “Sample Adult” component, which is part of a “nationally representative household survey of the civilian noninstitutionalized U.S. population.” The questionnaire was redesigned in 2019 to include questions related to individuals’ reasons for being uninsured.
That “major restructuring” has made it more challenging for researchers to identify trends, Garfield said.