Census data show health insurance coverage gains for Black workers and children in 2021, but we can go further with better policy
The number of workers with health insurance coverage grew between 2020 and 2021 as the economy recovered from the massive job losses associated with the coronavirus pandemic. Most people (91.7%) had health insurance coverage at some point during the year and the share of uninsured people fell from 8.6% in 2020 to 8.3% in 2021.
Notably, the share of Black people who were uninsured fell from 10.4% in 2020 to 9.0% in 2021, marking a rare occurrence in which the Black uninsured rate fell below double digits.
In 2021, most people (54.3%) had health insurance through an employer (either their own employer or a family member). The share of people with private health insurance of any kind (employment-based or through individual purchase) fell slightly to 66.0%, while the share of those with a public plan rose to 35.7% (note that coverage types are not mutually exclusive – one person can have two types of health insurance coverage).
The drop in private coverage in 2021 came largely from rates falling among those aged 65 and older, while those under the age of 65 saw increased utilization of public health insurance, particularly Medicaid. This trend has been consistent throughout the pandemic as states expanded coverage in response to the federal “continuous coverage requirement,” where states that allow participants to maintain coverage even through a change in income eligibility saw an increased federal Medicaid match rate of up to 6.2%. In the previous measurement period before the pandemic (2018-2020), Medicaid coverage remained basically flat while private insurance coverage fell, which increased uninsurance rates among Black Americans and those living below the poverty line.1
This expansion in public health insurance coverage drove the uninsurance rate down to 9.0% for Black people in 2021. Black children and working-age adults saw their uninsured rates fall significantly, from 5.9% to 4.3% for children and from 14.2% to 12.7% for adults. We can see consonant improvements in insurance rates in the South and for those living below the poverty line—all signs indicate the expansion in Medicaid enrollment eligibility through the public health emergency has had a significant, positive impact on health insurance coverage.
Expanded public health insurance coverage reduced Black uninsured rates in 2021: Uninsured rate by race and Hispanic origin, 2020 and 2021
|Hispanic (any race)||18.3||18.3|
Source: EPI analysis of Keisler-Starkley, Katherine and Lisa N. Bunch, Health Insurance Coverage in the United States: 2021, U.S. Census Bureau report #P60-278, September 2022.
Still, there is significant progress to be made towards the goal of giving all Americans access to affordable medical care. Hispanic Americans, who regularly have the highest rates of uninsurance, due to a comparative lack of coverage through employment and eligibility issues related to immigration, saw no significant change in their uninsured rate of 18.3% between 2020 and 2021.
The rise in uninsurance among Asian Americans is driven by Asian American children who saw a significant increase in their uninsured rate, from 2.8% in 2020 to 4.6% in 2021. Though the expansion of coverage we saw during the pandemic brought many people who are normally sidelined into more consistent coverage, there are still clear gaps in the current health insurance system that remain to be addressed.
The success of the continuous enrollment requirement proves the utility of policy levers to get people the coverage they need and underscores the potential consequences for allowing the program to expire with the end of the public health emergency. Across studies, the primary reasons given for medical care avoidance center around issues of affordability and access to health insurance.2 Movement toward a system that allows for improved affordability and coverage will likely lead directly to better health outcomes for the populations that increase their use of medical care. Expanded access to health insurance through a program like Medicare for All is not just smart economics, but a moral issue.
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