The number of people with health insurance decreased to 253.6 million in 2009 from 255.1 million in 2008, the Census Bureau reported today. This is the first time that the number of people with health insurance has decreased since 1987, the first year that comparable health insurance data were collected. The ranks of those with employer-based insurance and other forms of private coverage decreased, while coverage increased for government programs such as Medicaid and the Children’s Health Insurance Program.
In 2009 there were 50.7 million uninsured people in the country, or 16.7% of population. These figures are up from 46.3 million uninsured people, or 15.4% percent of the population, in 2008.
The new Census numbers are based on the 2010 Current Population Survey (CPS) Annual Social and Economic Supplement. The CPS counts as uninsured Americans who report that they lacked coverage throughout all of the preceding year, but the survey is thought to overestimate the number of full-year uninsured people for several reasons. Appendix C of the new Census Bureau report discusses these methodological issues.
Private and employer-based coverage. Between 2008 and 2009, the percentage of people covered by private health insurance decreased from 66.7 percent to 63.9 percent, and the percentage of people covered by employment-based health insurance decreased from 58.5 percent in 2009 to 55.8 percent in 2009. The percentage of people covered by employment-based health insurance is the lowest since 1987. The number of people covered by employment-based health insurance decreased to 169.7 million in 2009, from 176.3 million in 2008.
Do the Census numbers indicate that the decline in employer-based coverage was due to employers deciding not to offer coverage, or to workers losing their jobs? During a media briefing on the new CPS numbers, David Johnson, chief of the Census Bureau’s Housing and Household Economic Statistics Division, suggested that much of the decline in coverage was due to changes in employment status. “We found a lot of people moving from full-time to not full-time, or from working to not working,” Johnson said, and he added: “People who were not full-time year round workers, their uninsured rate went up by 2.7 percentage points – so that’s a lot worse. People who worked full-time year-round, their uninsured rate went up only six-tenths of a percentage point.” [not statistically significant] (For more on trends in employer-based coverage, check out this recent Health Affairs article.)
Government health insurance programs. In contrast to the picture for private and employer-sponsored coverage, the percentage of people covered by government health insurance programs increased to 30.6 percent in 2009, from 29.0 percent in 2008. This is the highest percentage of people covered by government health insurance programs since 1987. In 2009, Medicaid covered 15.7 of Americans, or 47.8 million, up from 14.1 percent, or 42.6 million, in 2008. The percentage and number of people covered by Medicaid is the highest since 1987.
The percentage and number of people covered by Medicare in 2009 (14.3 percent and 43.4 million) were not statistically different from 2008.