This election year, as debates over the effectiveness of the Affordable Care Act rise to the top of candidates’ priorities, new Census data reveals a significant drop in the national uninsured rate. It was confirmed that
New data shows that from 2013 to 2019, the uninsured rate among working-age adults (ages 18-64) decreased in all 50 states and the District of Columbia. Nationally, the uninsured rate decreased by 7.6 percentage points, from 20.5% to 12.9%. This decline was particularly pronounced in states that expanded Medicaid under the Affordable Care Act (ACA). Of the 11 states with the largest declines in uninsured rates (more than 10 percentage points), all were Medicaid expansion states.
Private insurance coverage has also expanded in most areas of the country. From 2013 to 2019, private reporting increased in 44 states and Washington, D.C., with Florida showing the largest increase, from 60.1% to 69.9%. No state reported a decrease in private insurance coverage during this period.
Public health insurance coverage followed a similar trend, increasing in 36 states. Medicaid expansion was a key driver of these changes, with 29 of the states with increasing participation rates expanding their Medicaid programs. Notably, New Mexico saw the largest increase in general coverage, from 19.1% to 32.5%. In contrast, national coverage declined in Maine, Texas, and Utah, which did not expand Medicaid.
This positive trend continued from 2019 to 2023, with 42 states seeing further declines in uninsured rates. By 2023, the national uninsured rate among working-age adults has decreased to 11%. Again, Medicaid expansion played a significant role in reducing the uninsured rate, with states that expanded the program seeing the largest declines. Public health insurance coverage increased in 36 states, with Oklahoma recording the largest increase.
Impact on the elderly
The uninsured rate for adults 65 and older has been significantly lower since 2013, hovering between 0.1% and 2.1%. From 2013 to 2019, changes in coverage through a combination of public and private insurance, such as Medicare and Medigap plans, reduced the uninsured rate for this group in 14 states. Although these older adults primarily rely on public systems such as Medicare, between 2013 and 2019 private insurance participation rates among this age group declined markedly, from 1.4 to 8.7 in 48 states. decreased in the range of percentage points.
During this period, public insurance for adults 65 and older decreased slightly in 23 states, but public insurance for this group remained strong overall, increasing from 90.6% of seniors to 98.4% of seniors across all states in 2019. % was covered.
From 2019 to 2023, this trend continued, as the uninsured rate among adults 65 and older increased in seven states, while public and private insurance rates began to decline. Private insurance participation rates declined in 42 states, and the national private insurance participation rate for seniors fell from 58% to 53.7%. Public insurance participation rates also declined in 35 states, but remain high, with 92.5% to 97.8% of adults in this age group expected to be eligible for Medicare or other public options by 2023.
Despite these changes, the uninsured rate among adults 65 and older has remained stable at the national level, largely due to the wide availability of Medicare. Public coverage is the predominant form of insurance for this group, and fewer people rely on a combination of Medicare and private plans like Medigap. This reflects a broader trend toward public-only insurance for seniors in the United States, especially as private insurance continues to decline in states.
The overall low uninsured rate among adults 65 and older and changes in public and private insurance coverage highlight the continued evolution of health insurance for America’s aging population.
Uninsured rates: children, working age adults
From 2019 to 2023, the uninsured rate among children and working-age adults decreased significantly in several major metropolitan areas. Recent data shows that the uninsured rate for children under age 19 in large cities like Atlanta, Chicago, and Los Angeles has decreased significantly over this period. This reflects broader national trends, particularly in states that expanded Medicaid under the Affordable Care Act (ACA).
For working-age adults (ages 19 to 64), uninsured rates decreased in nearly all metropolitan areas. The Miami metropolitan area saw the most dramatic decline, with its uninsured rate dropping from 21.9% in 2019 to 16.5% in 2023. This is consistent with Florida’s overall uninsured rate decreasing from 19.5% to 15.5% over the same period.
However, some metropolitan areas had mixed results for adults 65 and older. Detroit’s uninsured rate increased slightly from 0.4% to 0.7%, reflecting a similar trend in Michigan. In contrast, the Washington, DC metropolitan area saw a slight decrease from 1.6% to 1.2%.
From 2013 to 2019, the implementation of the ACA significantly expanded health insurance coverage, with the largest increases in private and public coverage for working-age adults and children. ACA-related policies, such as Medicaid expansion and marketplace coverage, also contributed to the overall decrease in uninsured rates across age groups. However, from 2019 to 2023, the pace of expansion of coverage, particularly in private insurance, slowed.
For seniors, the ACA made Medicare more affordable, lowering uninsured rates from 2013 to 2019. However, trends have stabilized from 2019 to 2023, with uninsured rates remaining low for this group, although some regions are experiencing some fluctuations.
Overall, the data demonstrate the ACA’s continued impact on reducing uninsured rates for children, working-age adults, and older Americans. However, the slowing growth in private health insurance since 2019 indicates continued challenges in expanding access to health care across the country.
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Doug Bailey is a journalist and freelance writer living in the Boston suburbs. He can be reached at (email protected).
