On September 12, 2017, the United States Census Bureau released its report on Health Insurance Coverage in the United States for 2016. The report is based on data collected by the Census Bureau’s Current Population Survey Annual Social and Economic Supplement and American Community Survey. The report summarizes the status of the American insured and uninsured population during the last year of the Obama presidency, thus creating a baseline for what follows.

After a sharp drop in the number of the uninsured and expansion of insurance coverage following the full implementation of the Affordable Care Act in 2014, insurance coverage has stabilized in the United States. The percent of people in the United States uninsured for the entire year fell from 9.1 percent (29 million) in 2015 to 8.8 percent (28.1 million) in 2016, with insurance coverage changing marginally for most forms of coverage. The only statistically significant gain in coverage (0.4 percent) was in the Medicare population. A total of 67.5 percent of Americans had private coverage and 37.3 percent had government coverage, with employer coverage insuring the largest percentage of the population (55.7 percent).

The percentage of people lacking insurance coverage fell for most age groups under age 65, with generally larger decreases for working-age adults (although working-age adults are less likely to be covered than children or adults over age 65). The percentage of uninsured children remained largely unchanged at 5.4 percent. Hispanics continued to have the highest uninsured rate (16 percent) and non-Hispanic whites the lowest rate (6.3 percent).

As in the past, married individuals were more likely to be covered (91.2 percent) than people who were widowed or divorced (86.1 percent), never married (84 percent), or separated (80.8 percent). Full-time, year-round workers were more likely to be covered (90.2 percent) than part-time or part-year workers (85.2 percent) or non-workers (85 percent). Higher-income people were more likely to be covered than lower-income: 95.8 percent of people with a household income of $125,000 or more had coverage, compared to only 86.3 percent of those with an income of less than $25,000. However, 68 percent of people with incomes below $25,000 had government coverage compared to only 18.8 percent of those with incomes at or above $125,000. Between 2015 and 2016, the coverage rate increased 1.1 percent for people with incomes below 100 percent of the federal poverty level but decreased 1 percentage point for those with incomes between 200 and 299 percent of poverty.

Between 2015 and 2016 the uninsured rate dropped in 39 states and did not statistically significantly change in the other 11. The average uninsured rate is lower in states that expanded Medicaid (6.5 percent) than in states that did not expand Medicaid (11.7 percent). Indeed, the ACA’s Medicaid expansion seems to be the most important factor explaining the decline in the uninsured since 2013. The uninsured rates vary from 2.5 percent in Massachusetts to 16.6 percent in Texas.

CMS Opens Oregon 1332 Waiver Application For Comment

On September 11, 2017, the Centers for Medicare and Medicaid Services declared Oregon’s 1332 waiver complete and opened it up for a 30-day comment period. Oregon is asking for a waiver to fund a reinsurance program, which would be partially funded by a state health insurance tax. Like the Minnesota’s 1332 proposal, Oregon’s proposal would reinsure claims that exceeded an attachment point at a specified percentage rate up to a cap, instead of reinsuring cases with particular conditions as Alaska will do in its 1332 waiver program.