Health Advice



Census: Insured population holds steady, with a slight shift from private to public coverage

Victoria Knight and Julie Appleby, Kaiser Health News on

Published in Health & Fitness

Despite a pandemic-fueled recession, the number of uninsured Americans has increased only slightly since 2018, according to Census Bureau health insurance data released this week.

Twenty-eight million people, or 8.6% of Americans, were uninsured for all of 2020. In 2019, 8% of people were uninsured during the full year; in 2018, it was 8.5%.

During a news conference Tuesday, Census Bureau officials said there was no statistically significant difference in the number of uninsured when comparing 2018 and 2020 data. (The Census Bureau has cautioned against comparing 2020 data to 2019 data because of a disruption in data collection and individual responses due to the COVID-19 pandemic — which is why 2018 served as the primary comparison.)

“It’s remarkable that, during a pandemic with massive job losses, the share of Americans uninsured did not go up,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. “This is likely a testament to what is now a much more protective health insurance safety net.”

Still, the annual report shows a shift in where Americans get their insurance coverage. Private insurance coverage decreased by 0.8 percentage points from 2018. Public coverage rose by 0.4 percentage points from 2018. That shift was likely driven partly by older Americans becoming eligible for Medicare, at age 65, and showed a 0.5 percentage point increase from 2018 to 2020.

Coverage through employers also dropped significantly, said Joseph Antos, a senior fellow in health care policy at the American Enterprise Institute, and low-income people were hit especially hard as pandemic cutbacks led to job and health insurance losses. Employment-based coverage dropped by 0.7 percentage points compared with 2018.


The census 2020 data did show a decline in the number of workers employed full time year-round, and an increase in the number of workers who worked less than full time, suggesting that many individuals shifted to part-time work.

This changing nature of work is “part of the overall story,” said Sharon Stern, assistant division chief of employment characteristics at the Census Bureau. For the group that didn’t work full time, the uninsured rate increased to 16.4% in 2020 from 14.6% in 2018. And that impact was concentrated at the bottom of the earnings index.

“Almost certainly, the people most prone to lose coverage because they lost their jobs were lower-paid workers to begin with,” Antos said.

Antos said the Census Bureau data, which showed there wasn’t a significant difference between 2018 and 2020 in the percentage of Americans covered by the Affordable Care Act, misses the larger role the ACA played in helping those who lost coverage get it through the program. Many of those who looked into ACA plans may have met income requirements for Medicaid and joined those rolls instead. Medicaid is a federal-state program for the poor and coverage is free or available at a very low cost. Even with a subsidy, many ACA enrollees may face premium or deductibles or both.


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