Private health coverage continues to decline, but Medicaid and CHIP cover more kids

Washington -- The growth in the uninsured adult population continued in 2010 -- in particular the number of long-term uninsured and poorer uninsured -- according to a government estimate.

The number of Americans of all ages who were uninsured at any point in the past 12 months reached 60.3 million in 2010, an increase of nearly 2 million from 2009, according to a June 22 report by the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention.

Private health coverage continued to decline while public coverage increased, especially for children. Among nonelderly adults, 61.1% had private coverage in 2010, a drop of 1.7 percentage points. The rate of privately covered children decreased by 1.9 percentage points to reach 53.8%.

But while more adults became uninsured, fewer children overall lost coverage, according to the report. That's largely because the percentage of kids with public coverage -- Medicaid and the Children's Health Insurance Program -- increased to 39.8%, up nearly two percentage points.

"Medicaid and CHIP have been a real success story," said Tom Buchmueller, PhD, a University of Michigan health economist. State expansions of these programs for children began boosting the percentage of publicly covered children starting in 2008, according to the report's estimates.

The annual CDC numbers serve as an early indicator of trends that might be highlighted in the upcoming U.S. Census Bureau uninsured estimates, typically released in late August. The Census report is generally regarded as a snapshot of the uninsured population. The CDC report provides uninsured status in more detail -- at the time of the survey, during any part of the year, and lasting more than a year.

The continued decline in private coverage in 2010 especially affected nonelderly adults earning from 100% to 200% of the federal poverty level, or $10,890 to $21,780. Few states offer Medicaid coverage to this near-poor population, and their private insurance options may be limited. The uninsured rate for this group increased by nearly four percentage points in 2010 to reach 43%. Meanwhile, 34.7% of the same population had private coverage, a drop of three percentage points.

"That's really the group that's poised to gain the most from the Affordable Care Act," Buchmueller said, referring to the health system reform law. Adults earning up to 133% of the federal poverty level will qualify for Medicaid under the law. Subsidies also will be available for purchasing private coverage to those earning between 133% and 400% of poverty.

High unemployment from the recession is probably the main reason nearly 3 million more people reported being uninsured for more than a year in 2010 than in 2009, said Peter Cunningham, PhD, director of quantitative research at the Center for Studying Health System Change, a research group in Washington, D.C.

Buchmueller questioned why residents in some of the states with the highest uninsured populations have elected leaders who are campaigning against the health reform law's coverage expansions. But Cunningham said not everyone who is uninsured will support candidates who want to expand public coverage. "That's one of the paradoxes," Cunningham said.

Some political leaders are skeptical about the effectiveness of public coverage such as Medicaid. Surveys have documented Medicaid and CHIP enrollees' difficulty accessing certain types of care compared with the privately insured. "They may get coverage, but they may still have trouble finding a doctor," Buchmueller said.

Although more than 75% of physicians in America participate in Medicaid or CHIP, only 47% of these doctors take all new Medicaid or CHIP enrollees, according to a June 30 Government Accountability Office report. Meanwhile, 79% of the same physicians accept all new privately insured patients. The results are based on a national survey of 932 primary and specialty physicians conducted by GAO between August and October 2010.

But judging by other measures -- such as preventive care -- many Medicaid and CHIP programs achieve quality similar to private health plans. For example, Medicaid and CHIP children in 36 states were as likely or more likely than privately insured kids to have had at least one preventive health care visit during a 12-month period, according to the 2007 National Survey of Children's Health.