By Jane Norman, CQ HealthBeat Associate Editor
September 13, 2011 -- While at least for the moment, a majority of Americans receive their health insurance through their employers, recently released Census Bureau estimates indicate that might not be the case for long.
Even before the economic downturn began, the share of people enrolled in employer-sponsored insurance was declining. Census figures for 2010 show that it now stands at 55.3 percent, raising the prospect it may slip below the majority mark within a few years.
The 2010 percentage was down just slightly from 56.1 percent in 2009—but it's dramatically lower than the 64 percent of Americans who had employer-sponsored coverage in the relatively buoyant days of 1999.
To supporters of the president's health care law (PL 111-148, PL 111-152), this trend demonstrates the need for the framework the law establishes for providing insurance and extending new consumer protections in the individual market. Both the rate and number of people covered by insurance they buy on their own—a traditionally expensive and problem-fraught market—rose in 2010 to an estimated 9.8 percent—30.1 million people.
The liberal-leaning Families USA said in a written statement that the decline in employer coverage has been driven by the sharp increase in health insurance premiums. Such increases have forced businesses to drop their plans and provisions in the law that assist small businesses in buying insurance for workers will be helpful, the group said.
But for the law's opponents, the trend away from employer or other private insurance shows an alarming shift to reliance on such public programs as Medicare and Medicaid whose costs are rising—and which may be targets for deficit reduction. The census said that 31 percent of Americans now are covered by a government plan, compared to 30.6 percent in 2009 and 24.2 percent in 1999.
"It's a concern for those who want to preserve the private market," said Nina Owcharenko, director of the Center for Health Policy Studies at the conservative Heritage Foundation. The percentages of those enrolled in public programs will also rise as the Medicaid law is extended to millions more enrollees in 2014.
Plenty of people remain uninsured, the estimates found, though as ever the percentages and numbers vary by age, region of residence and ethnicity.
For example, most regions showed no statistical differences in the uninsured rate with the exception of the Northeast, where the numbers rose to 6.8 million uninsured from 6.4 million in 2009. The Northeast, which includes states like Massachusetts with universal coverage, still had the lowest uninsured rate of the country's four regions—12.4 percent.
The census numbers were included in the annual report on income, poverty and health insurance coverage in the United States and covered the first full calendar year following the recession - as officially designated - from December 2007 to June 2009.
The Census Bureau reported that 16.3 percent of Americans did not have health insurance in 2010, a figure not statistically different from 2009. However, the number of people without insurance rose slightly from 49 million to 49.9 million.
Census officials said that revisions in the way the figures on health insurance are estimated prompted a revision of last year's data, and they released a paper detailing the statistical methods used. The result slightly reduced the rate of the uninsured in 2009 from the 16.7 percent reported last year to 16.1 percent. Robert Greenstein and other officials at the liberal-leaning Center on Budget and Policy Priorities said the revision produced more accurate estimates; some analysts have been critical of census health insurance estimating approaches in the past.
White House officials pointed out that the data showed a clear benefit from the health care law provision that allows young adults to remain on their parents' policies until the age of 26. It took effect for plan renewals beginning on Sept. 23.
The percentage of young adults ages 18 to 24 with insurance increased from 70.7 percent in 2009 to 72.8 percent in 2010, Health and Human Services Secretary Kathleen Sebelius said in a blog post.
"We expect even more will gain coverage in 2011 when the policy is fully phased in," she said. The gain was key because young adults traditionally make up the largest group of uninsured people.
For those older than 34, though, the outlook wasn't as promising, perhaps indicating the toll that economic problems has taken among older people.
Among Americans 25 to 34, the uninsured rate of 28.4 percent wasn't statistically different from 2009, but for those 35 to 44 it went up from 21 percent to 21.8 percent. For those 45 to 64, it rose from 15.6 percent to 16.3 percent. Even among people over 65, presumably eligible for Medicare, the uninsured rate increased from 1.7 percent to 2 percent.
The estimates also showed that in 2010, 9.8 percent of children under age 18 lacked health insurance, which was not statistically different from 2009 estimates. Among children in poverty, though, 15.4 percent were uninsured in 2010.
Among ethnic groups, the census said 30.7 percent of Hispanics are uninsured, much higher than the national average. But that was actually a decrease from 2009 when it was 31.6 percent. The uninsured rate for blacks was 20.8 percent and it was 11.7 percent for non-Hispanic whites in 2010. There was a rise in the uninsured among Asians, from 16.5 percent in 2009 to 18.1 percent in 2010.