By Robin A. Cohen, Ph.D., Michael E. Martinez, M.P.H., M.H.S.A., and Emily P. Zammitti, M.P.H.
U.S. Department of Health and Human Services, National Center for Health Statistics, August 2018
* In the first 3 months of 2018, 28.3 million (8.8%) persons of all ages were uninsured at the time of interview—not significantly different from 2017, but 20.3 million fewer persons than in 2010.
* In the first 3 months of 2018, among adults aged 18–64, 12.5% were uninsured at the time of interview, 19.2% had public coverage, and 70.0% had private health insurance coverage.
* In the first 3 months of 2018, among children aged 0–17 years, 4.6% were uninsured, 41.9% had public coverage, and 54.6% had private health insurance coverage.
* Among adults aged 18–64, 70.0% (138.6 million) were covered by private health insurance plans at the time of interview in the first 3 months of 2018. This includes 4.2% (8.3 million) covered by private health insurance plans obtained through the Health Insurance Marketplace or state-based exchanges.
* The percent age of persons underage 65 with private health insurance enrolled in a high-deductible health plan increased, from 43.7% in 2017 to 47.0% in the first 3 months of 2018.
By Don McCanne, M.D.
This annual NHIS study of the uninsured done by the National Center for Health Statistics gives us the most accurate status of health insurance coverage in the United States. A few observations can show us how our system is functioning, now that the implementation of the Affordable Care Act (ACA) has relatively stabilized:
* 28.3 million individuals (8.8%) remain uninsured, the same as last year, so net enrollment seems to have stabilized for the present, with still far too many remaining uninsured.
* Of adults aged 18-64, 138.6 million were covered by private insurance, though only 8.3 million of them were covered through the ACA exchanges, which makes you think that there must be a better option considering the administrative complexity of the program.
* For children aged 0-17, the increase in public coverage (Medicaid and CHIP) reduced their uninsured rate to 4.6%, but most of that increase was prior to the implementation of ACA. Although many consider an uninsured rate of 4.6% for children to be a policy success, we really should ask why we tolerate leaving 3.4 million children uninsured when a well designed single payer system would cover all of them, and everyone else.
* One statistic that is not stable is that the percentage of individuals under age 65 with private health insurance who are enrolled in high-deductible health plans increased from 43.7% to 47.0% in the last year alone, and is up from 25.3% in 2010. This may be the most shocking result reported this year since it demonstrates that the rate of underinsurance, with its consequential epidemic of financial hardship, is skyrocketing.
Although many in the policy community will celebrate these results as a success of the Affordable Care Act, these are actually terrible results. We could have had everyone covered in a program that we could all afford, but instead our policymakers rejected single payer Medicare for all and have left us with tens of millions uninsured, almost half of the privately insured with worsening underinsurance, and persistent unjust inequities in health care coverage. Are we nuts?
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