What Does the CPS Tell Us About Health Insurance Coverage in 2020?

As job and earnings losses mounted throughout 2020, many specialists feared the financial upheaval attributable to the COVID-19 pandemic would result in disruptions in well being protection and will increase within the variety of individuals with out medical health insurance. But, as a consequence of delays or information high quality issues in federal surveys sometimes used to measure well being protection within the US, there was restricted complete information to measure what occurred to the variety of uninsured individuals throughout 2020. The current launch of the Census Bureau’s Present Inhabitants Survey (CPS) Annual Social and Financial Complement (ASEC) offers information on adjustments to well being protection throughout 2020. The info present that the quantity of people that have been uninsured and the uninsured charge held regular in 2020.

This information be aware offers extra context and evaluation to grasp the 2020 CPS findings. It describes developments in well being protection previous to and in the course of the pandemic and examines the traits of the uninsured inhabitants in 2020. We deal with nonelderly individuals, since there’s nearly common protection amongst these age 65 and over due to Medicare. As a consequence of recognized information high quality points with the 2019 CPS ASEC information, which was collected in March 2020 simply on the onset of the pandemic and skilled low response charges, we use 2018 for comparisons to pre-pandemic protection. We additionally talk about doable causes for the steadiness in protection proven within the current information, together with ongoing challenges with measuring protection in the course of the pandemic.

What occurred to well being protection in 2020?

  • In 2020, 27.4 million nonelderly individuals have been uninsured, and the uninsured charges was 10.2%. The uninsured charge was unchanged from 2018 however was increased than the uninsured charge in 2016 (9.1%) (Appendix Desk A). The quantity of people that have been uninsured in 2020 grew by greater than 2.5 million from 2016 (Determine 1).

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  • Protection declines lately reverse a pattern that started following enactment of the ACA in 2010, when protection for younger adults under age 26 and early Medicaid enlargement went into impact, and the variety of uninsured individuals and the uninsured charge started to drop. When the main ACA protection provisions went into impact in 2014, the variety of uninsured and uninsured charge dropped dramatically and continued to fall by 2016.
  • For the nonelderly inhabitants, well being protection kind remained surprisingly fixed in 2020 in comparison with 2018. Just like 2018, 58.7% of the nonelderly inhabitants was lined by employer-sponsored insurance coverage, 6.4% bought non-group protection, 20.2% had Medicaid, and 4.5% had Medicare or navy protection in 2020 (Determine 2, Appendix Desk A).

  • For many demographic teams, adjustments within the uninsured charges from 2018 to 2020 weren’t considerably completely different. Nevertheless, the uninsured charge amongst nonelderly non-Hispanic Black individuals elevated from 10.5% in 2018 to 11.7% in 2020 whereas the speed for Asian individuals decreased from 7.7% in 2018 to six.4% in 2020 (Determine 3).

  • Having a full-time, full-year job in 2020 diminished the chance of changing into uninsured. Amongst nonelderly adults working lower than full-time full-year, the uninsured charge elevated to 16.4% in 2020, up from 14.6% in 2018. In distinction, the uninsured charge for full-time full-year nonelderly grownup staff was 8.4% in 2020, a decline of 1.1 share factors from 2018 (Determine 4).

Who remained uninsured in 2020?

  • Most (84.3%) of the nonelderly uninsured are nonelderly adults. The uninsured charge amongst kids was 5.6% in 2020, lower than half the speed amongst nonelderly adults (11.9%), largely as a consequence of broader availability of Medicaid and CHIP protection for youngsters than for adults (Appendix Desk B).
  • In 2020, over three quarters of uninsured people (76.1%) had at the least one full-time employee of their household and a further 11.2% had a part-time employee of their household (Determine 5).

  • People with earnings under 200% of the Federal Poverty Degree (FPL; the federal poverty degree was $20,852 for a household of two adults and a toddler in 2020) are on the highest danger of being uninsured. In whole, greater than eight in ten (82.6%) uninsured individuals have been in households with incomes under 400% of poverty in 2020 (Determine 5).
  • Folks of coloration make up 43.6% of the nonelderly inhabitants, however account for over six in ten (62.8%) of the uninsured inhabitants in 2020. Hispanic individuals comprised the biggest share of the uninsured (40.1%) whereas 37.2% of the uninsured are non-Hispanic White individuals (Determine 5). Typically, individuals of coloration are at increased danger of being uninsured than White individuals. Hispanic, Black, and American Indian/Alaska Native individuals all have considerably increased uninsured charges than White individuals (6.7%) (Determine 3).


Regardless of a public well being disaster that induced important financial turmoil, the CPS information point out that well being protection throughout 2020 was comparatively secure in comparison with earlier than the pandemic. In line with the info, the uninsured charge didn’t improve, and the share of individuals with personal protection by an employer and bought instantly within the particular person market in addition to these with Medicaid protection didn’t change in comparison with 2018. Whereas protection total was regular, sure teams skilled a larger danger of changing into uninsured in 2020, together with nonelderly Black people and nonelderly adults who labored lower than full-time.

The survey findings are per different analyses of well being protection adjustments throughout 2020 that recommend job losses have been increased than declines in employer-sponsored protection. These analyses conclude that job losses occurred primarily amongst decrease earnings staff who have been much less more likely to receive well being protection by their employer. Consequently, these people didn’t lose employment-based protection after they misplaced their jobs. They could have already been uninsured or had protection by one other supply, resembling Medicaid or the ACA Market. Additionally, some individuals who misplaced their jobs have been positioned on short-term furlough, and employers might have continued their well being advantages. Moreover current will increase in Market protection, pushed partly by extra beneficiant subsidies made out there by the American Rescue Plan Act, occurred throughout 2021 and wouldn’t be captured within the 2020 information. Nevertheless, administrative information suggests declines in employer protection have been considerably bigger than prompt by the CPS.

Nevertheless, the survey findings are considerably much less per administrative information exhibiting giant will increase in Medicaid enrollment in the course of the pandemic. Following implementation of the ACA’s Medicaid enlargement, enrollment in Medicaid elevated as many low-income working adults who didn’t have protection by their jobs turned eligible for Medicaid. Whereas enrollment dropped in 2019, administrative information point out Medicaid enrollment has grown by almost 15% because the begin of the pandemic. From 2018 to 2020, common month-to-month Medicaid enrollment elevated by 4% in response to administrative information, a rise not mirrored within the CPS. Provisions within the Households First Coronavirus Response Act (FFCRA) that require states to make sure steady protection for these enrolled in Medicaid as of March 18, 2020 to be eligible for enhanced federal Medicaid matching funds in the course of the COVID-19 public well being emergency (PHE) contributed to the enrollment development.

A number of the discrepancies famous above could also be associated to the way in which by which the survey counts uninsured individuals or to ongoing challenges with response charges. The CPS counts individuals as uninsured in the event that they lack protection for the complete 12 months and thus doesn’t seize those that might have misplaced insurance coverage in the course of the 12 months. Different analyses of month-to-month information on well being protection from the CPS ASEC reveals {that a} increased share of adults have been uninsured for a part of the 12 months in 2020 in comparison with 2018, indicating that adults might have been extra more likely to lose protection in 2020 than in 2018 (charges of part-year protection for youngsters have been the identical in 2018 and 2020). Additionally, KFF evaluation of the March 2021 point-in-time protection estimates reveals a better uninsured charge (10.8% as March 2021 versus 10.2% for full-year 2020), additional indicating some lack of protection as a result of pandemic. As well as, although the Census Bureau made changes within the 2020 information assortment to account for ongoing points with response charges, there’s proof suggesting that the nonresponse bias persists with the 2020 information, particularly amongst decrease earnings people. The CPS additionally depends on respondents self-reporting their well being protection, which can not match administrative information.

Because the US strikes ahead from the pandemic, persevering with financial challenges and the unwinding of the PHE may result in protection disruptions within the coming 12 months. Though the financial system is rebounding, not the entire new jobs present well being protection. Moreover, when the continual protection necessities in Medicaid finish, states might want to redetermine eligibility for present enrollees, a course of that may result in lack of protection even amongst those that stay eligible. Continued efforts will likely be essential to make sure individuals who could also be vulnerable to dropping protection are conscious of and related to potential different protection choices.

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