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Number of Uninsured in United States Grows to 49.9 Million; Young Adults Already Benefitting from the Affordable Care Act

New data released by the U.S. Census Bureau today show that the number of people without health insurance climbed to 49.9 million in 2010, up from 49 million in 2009 (Exhibit 1). More than 13 million more people were without health insurance in 2010 than in 2000.

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But the Census report also shows a reversal in the decade-long increase in the number of young adults without health insurance, which is likely attributable to the Affordable Care Act: young adults under age 26 may now stay on or join their parent’s health plans. The percentage of uninsured young adults ages 18 to 24 without health insurance declined by more than 2 percentage points, dropping to 27.2 percent in 2010, down from 29.3 percent in 2009 (Exhibit 2). This translates into 500,000 more young adults with insurance coverage in 2010 compared with 2009, with most of the increase coming from employer-based coverage. This is the largest one-year decline in uninsured young adults in the last 10 years.

The continuing high rates of unemployment in the United States left increasing numbers of people without job-based health insurance. The percentage of people with insurance coverage through an employer declined to 55.3 percent in 2010, with 1.5 million fewer people enrolled in employer plans than in 2009 (Exhibit 3). The Census Bureau reports that 48.4 million people ages 18 to 64 did not work at least one week in 2010, up from 45.4 million in 2009. Among people in that age group who were not working, nearly 30 percent were uninsured, two times the rate of people who were employed full time. A recent Commonwealth Fund survey found that a majority of people who lose a job with health benefits become uninsured.

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The decline in employer coverage was offset in 2010 by increases in coverage through public insurance programs, including Medicaid and the Children’s Health Insurance Program (CHIP). Children were especially protected by public coverage. The percent of children covered by Medicaid or CHIP increased to 34.8 percent in 2010, up from 33.8 percent in 2009. Still, there are 9.8 million children under the age of 18 who are uninsured.

Families with incomes under $50,000 continue to be the income group most likely not to have health insurance. Twenty-seven percent of people with incomes under $25,000 were without health insurance in 2010, with nearly a million more people in this income range losing coverage in 2010. Nearly 22 percent of those in families with incomes between $25,000 and $50,000 were uninsured. Families in this income range will realize the greatest benefits from the full implementation of the Affordable Care Act in 2014, through a substantial expansion in Medicaid and premium tax credits to offset the cost of private health plans to be sold through the new state insurance exchanges.

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Across the country, Massachusetts led the nation in coverage, with just 5 percent of its full population, which includes those over age 65, without health insurance (Exhibit 4). This stands in stark contrast to Texas, where a quarter of its full population is without health insurance, the highest rate in the U.S. Massachusetts implemented a universal health insurance system in 2006 much like the Affordable Care Act and has since experienced a steady improvement in insurance coverage across its population.

Looking Forward
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The new Census data reveal that the early provisions of the Affordable Care Act are already having an effect on health insurance coverage, with 500,000 more young adults covered in 2010 compared with 2009. But the erosion in employer coverage resulting from job losses in the recession and fewer companies offering health insurance underscores the need for federal and state policymakers to continue their work implementing the Affordable Care Act. After 2014, when the law is fully implemented, Americans will have new affordable and comprehensive health insurance options, significantly reducing the number of people in each state who lack health insurance.

Publication Details

Publication Date: September 13, 2011
Citation: S. R. Collins, T. Garber, and K. Davis, Number of Uninsured in United States Grows to 49.9 Million; Young Adults Already Benefitting from the Affordable Care Act, The Commonwealth Fund Blog, September 2011.


Sara Collins
Vice President, Health Care Coverage and Access, The Commonwealth Fund
Senior Analyst, Manatt Health Solutions
Professor Emerita in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health