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Census Report: No Significant Year-to-Year Changes in Health Coverage

By Rebecca Adams, CQ HealthBeat Associate Editor

September 17, 2013 --The U.S. Census Bureau released status-quo health insurance statistics last week that reveal a nation that has become increasingly reliant on government-provided health coverage over the past decade, a trend that continued in 2012 and is expected to become more pronounced as the overhaul is fully implemented.

But there were no major changes from last year. The number of people without insurance in 2012—48 million people—was not statistically different from the 48.6 million uninsured the year before. About 15.4 percent of the population lacked insurance in 2012, compared to 15.7 percent in 2011.

The percentage and number of people covered by government health insurance was statistically significant, as more Baby Boomers became eligible for Medicare and the number of people relying on coverage provided by the military edged up. The overall share of people using government health coverage rose to 32.6 percent—101.5 million people—in 2012, up from 32.2 percent—99.5 million people—in 2011.

While the increase in people getting government health benefits was small from 2011 to 2012, the growing use of government benefits over the past few years is notable. The percentage of people receiving health care coverage through the government in 1999 was 24.2 percent. During the economic downturn, as more people became eligible for Medicaid and more people aged into Medicare, the share of people getting government coverage swelled to 29.1 percent in 2008.

The percentage of people with employer-sponsored insurance fell from 64.1 percent of residents in 1999 to 54.9 percent in 2012.
Some changes related to the health overhaul law (PL 111-148, PL 111-152) had more of an impact in 2010 and 2011, said David S. Johnson, chief of the Social, Economic, and Housing Statistics Division of the U.S. Census Bureau. And any further impact from the law is likely to be evident after the coverage expansion takes hold in 2014.

One impact that was reflected in previous data on the uninsured was a reduction in the rate of uninsurance among 19-to 25-year-olds, a group that had been the most likely to be uninsured, with more than 30 percent of people in that age range historically without coverage.

But after the implementation of a provision in the health care that allows young adults to stay on their parents' coverage until age 26, the rate of people that age without insurance fell to 27.2 percent in 2012. Now people who are 19 to 25 are tied for the most likely to be uninsured with people who are 26 to 34 years old.

However, as new insurance marketplaces start next year and about half the states broaden their Medicaid programs as allowed under the law, experts project that more people will gain government-provided insurance. The Congressional Budget Office recently projected that the deficit will resume growing in the coming decade as spending on Social Security and health care rises.

Gail Wilensky, who ran the Medicare and Medicaid programs during the George H. W. Bush administration, said it is "a little disconcerting that as we try to climb out of the recession we're not making much headway with the uninsured, although it's not really surprising because the number of people employed has not changed a lot." Wilensky said the expansion of coverage in the next couple of years will make a difference, although it is unclear how quickly changes will take root.

"If what's offered in exchanges, once they've had time to settle down, looks more or less like employer-sponsored insurance, we'll see increasing numbers of workers working for all but the largest employers getting insurance through the exchanges if they can get a subsidy," said Wilensky. "But if it looks more like Medicaid, that transition will be slower. That'll just be one more component increasing the government share."

The data census officials released early last week came from the Income, Poverty, and Health Insurance Coverage: 2012 report. This week, another census report, the American Community Survey, is scheduled to be released that will show localized health insurance data.

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