Almost half of Americans are not adequately covered

Although more individuals were insured in 2022 than in previous years, the healthcare coverage they were able to secure may not have been adequate to cover their expenses. Several recent reports reveal the statistics of health insurance in the US as well as concerns for post-pandemic coverage for those individuals.

A report published by the U.S. Department of Health & Human Services (HHS) in August 2022 stated that, overall, there were significant gains in health insurance coverage in terms of the number of patients covered in 2021 and early 2022. Statistics show that:

• The nation’s uninsured rate declined significantly in 2021 and early 2022, reaching an all-time low of 8.0 percent for U.S. residents of all ages in the first quarter (January-March) of 2022, compared to the prior low of 9.0 percent in 2016.

• Approximately 5.2 million people – including 4.1 million adults ages 18-64 and 1 million children ages 0-17 – have gained health coverage since 2020.

• Uninsured rates among adults ages 18-64 declined from 14.5 percent in late 2020 to 11.8 percent in early 2022. 

• The uninsured rate among children ages 0-17, which had increased during 2019 and 2020, fell from 6.4 percent in late 2020 to 3.7 percent in early 2022.

• Approximately 5.4 percent of adults 18-64 reported having Marketplace coverage in early 2022 compared to 4.4 percent in 2020, reflecting approximately 2 million additional adult Marketplace enrollees – roughly half of the 4 million adults who gained health coverage over this period.

• Changes in uninsured rates from 2020 to 2022 were largest among individuals with incomes below 100% of the Federal Poverty Level (FPL) and incomes between 200% and 400% FPL.

• State-specific analyses using the American Community Survey show that the largest changes in the uninsured rate for low-income adults between 2018-2020 generally occurred in states that recently expanded Medicaid.

However, the results of a Commonwealth Fund survey published in September 2022 revealed that many adults in the US are not adequately covered:

• About 43% of working-age adults were inadequately insured in 2022, meaning they were either uninsured, had a coverage gap in the past year or had unaffordable coverage.

• For those on employer coverage, 29% were underinsured, while 44% of those with individual market and marketplace coverage were underinsured.

• High healthcare costs prevented or delayed care for 46% of respondents, and 42% said they had difficulties paying their medical bills or debt.

In fact, half of the survey participants said they would not be able to pay an unexpected medical bill of $1,000 within 30 days, including:

• 68% of low-income adults

• 69% of Black adults

• 63% of Latinx/Hispanic adults.

The survey also revealed that, among those who were inadequately insured:

• 9% were uninsured.

• 11% had a coverage gap over the past year.

• 23% had coverage that made accessing healthcare services unaffordable.

In regard to the expanding Medicaid coverage many people were able to secure over the past couple of years, HHS projects that once the COVID-19 public health emergency (PHE) expires:

• 17.4 percent of Medicaid and Children’s Health Insurance Program (CHIP) enrollees (approximately 15 million individuals) will leave the program.

• Children and young adults will be impacted disproportionately, with 5.3 million children and 4.7 million adults ages 18-34 predicted to lose Medicaid/CHIP coverage.

• Nearly one-third of those predicted to lose coverage are Latino (4.6 million) and 15 percent (2.2 million) are Black.

• Almost one-third (2.7 million) of those predicted to lose eligibility are expected to qualify for Marketplace premium tax credits. Among these individuals, over 60 percent (1.7 million) are expected to be eligible for zero-premium Marketplace plans under the provisions of the American Rescue Plan (ARP). Another 5 million would be expected to obtain other coverage, primarily employer-sponsored insurance.