HHS: Uninsured rates decline for younger Americans from 2019 through 2021

More Americans in key demographics that have been historically uninsured saw coverage gains from 2019 through 2021, a new federal report finds. 

The Department of Health and Human Services (HHS) released a report Friday detailing gains in coverage from 2019 through 2021. Officials attributed a decline in the uninsured rate from 11.1% in 2019 to 10.5% in 2021 due to expansions in Medicaid and other gains via the Affordable Care Act’s (ACA's) marketplace. 

“We know that access to quality, affordable healthcare is key to healthier lives, economic security, and peace of mind” said HHS Secretary Xavier Becerra in a statement. “As we move forward, [HHS] will continue to do everything we can to protect, expand and strengthen the programs that provide the quality, affordable healthcare Americans rely on and deserve.”

The report found that the decline in the uninsured rate in 2021 was the largest among people with household incomes between 100% and 250% of the federal poverty level. In 2021, the White House engaged in a special enrollment period as well as enhanced and expanded premium tax credits.

The enhanced credits were recently extended through 2025 as part of the Inflation Reduction Act passed last year. 

Those credits helped lower the cost of insurance for low-income ACA consumers and are a key driver of record enrollment of 15.9 million people for the latest 2023 open enrollment

There were also larger gains in coverage among demographic groups that had high uninsured rates historically. 

For example, adults ages 19 to 34 and 35 to 49 uninsured rates both declined by one percentage point. Latino individuals also saw the uninsured rate decline by one percentage point. 

The gains in coverage varied at times between states, with ones that expanded Medicaid under the ACA having the largest increases.

Maine saw the largest decline in its uninsured rate by 3.2 percentage points from 2019 through 2021. Idaho came in second with 2.1 percentage points during the same time period. 

Researchers analyzed data from 2019 and the newly released 2021 American Community Survey, which surveys Americans on several topics including insurance coverage.

The report also investigated the reasons people go without health coverage. 

“The most common barrier cited by people without insurance is cost, with more than 70% of uninsured people reporting that health coverage was unaffordable,” the report said. 

It remains unclear what impact upcoming changes could leave on uninsured rates, especially among those who got coverage via Medicaid. 

States have not dropped anyone off Medicaid since early 2020 in exchange for a boost to its federal matching rate payment for Medicaid. The continuous coverage requirement was supposed to run through the COVID-19 public health emergency, but Congress passed a law late last year that enabled states to start Medicaid eligibility redeterminations this April.