HHS: U.S. uninsured rate reaches record-low 8% in Q1 amid ACA, Medicaid gains

The national uninsured rate reached a record low of 8% early this year amid record enrollment in Affordable Care Act exchanges and Medicaid, according to new federal data. 

The Department of Health and Human Services released a report on Tuesday finding that 5.2 million people got coverage since 2020, and the 

“Our new report shows that the uninsured rate in the country reached an all-time low this year — welcome news and proof that our efforts to protect and expand on the Affordable Care Act are paying off,” HHS Secretary Xavier Becerra said in a statement. 

The report examines coverage changes in the first quarter of the year based on new data from the National Health Interview Survey. 

The decline of the uninsured rate to 8%, the lowest on record, in the quarter stems from several factors. For instance, HHS found uninsured rate changes from 2020 to 2022 were the largest among people who earned below 100% of the federal poverty level and incomes between 200 and 400% of the poverty level. 

State estimates from 2020 onward are not available yet, but researchers did find that from 2018 to 2020 the largest changes in the uninsured rate for low-income Americans came in states that expanded Medicaid under the ACA. 

It also found that the uninsured rate of individuals who earned between 200 and 400 of the poverty level decreased two percentage points from 11.7% in the first quarter of 2021 and 9.7% in the same period this year. 

There was also a slight reduction among people who earned more than 400% of the poverty level declined from 4.2% in 2021 to 3.7% in the same period. 

The declines in enrollment coincide with several policies aimed at expanding insurance coverage, chief among them a boost to ACA subsidies installed for 2021 and 2022 and expanded outreach, HHS said in the report.

The boosted ACA subsidies helped fuel a record-breaking 14.5 million enrollment for the 2022 coverage year. The subsidies, however, are going to expire after this year unless Congress acts

Other possible drivers of the uninsured rate decline could go away. 

The pandemic fueled major gains in Medicaid enrollment thanks in part to an enhanced federal matching rate. States which agreed to take on the extra federal funds agreed to not drop anyone off Medicaid for the duration of the COVID-19 public health emergency (PHE).

However, these gains could go away after the PHE expires as early as this fall. States have 14 months after the PHE goes away to redetermine eligibility for Medicaid.